Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO00523 | KY |
NPI | 1578531273 |
---|---|
Provider Name | Gretchen Kay Malone |
First Address | Louisville, KY 40207-2342 |
Second Address | Louisville, KY 40207-2342 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 06/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
90006156 | (05) | KY |