Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | R5395 | KY |
NPI | 1578921896 |
---|---|
Provider Name | Audrey Lane |
First Address | Taylorsville, KY 40071-6910 |
Second Address | Mount Sterling, KY 40353-9792 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2016 |
Last Update Date | 24/10/2019 |