Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 240663 | KY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1164928008 |
---|---|
Provider Name | Ann Wade |
First Address | Lexington, KY 40514-1772 |
Second Address | Owingsville, KY 40360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2018 |
Last Update Date | 01/07/2019 |