Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | R3317 | KY |
N | 225X00000X | Occupational Therapist | R3317 | KY |
Y | 225XH1200X | Occupational Therapist - Hand | 133548 | KY |
N | 225XH1200X | Occupational Therapist - Hand | R3317 | KY |
NPI | 1033132550 |
---|---|
Provider Name | Mr. Jerry Roberts Abney JR. |
First Address | Lexington, KY 40504-3756 |
Second Address | Lexington, KY 40504-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 09/04/2019 |