Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 175128 | KY |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 175128 | KY |
NPI | 1205339256 |
---|---|
Provider Name | Mr. Jeffrey Couch |
First Address | Glasgow, KY 42141-1030 |
Second Address | Glasgow, KY 42141-1030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2018 |
Last Update Date | 01/12/2018 |