Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | KY-R3554 | KY |
NPI | 1194180737 |
---|---|
Provider Name | Casey Humphrey |
First Address | Georgetown, KY 40324 |
Second Address | Georgetown, KY 40324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2015 |
Last Update Date | 28/12/2015 |