Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | R0235 | KY |
NPI | 1003151622 |
---|---|
Provider Name | Ms. Constance Elaine Bruton |
First Address | Louisville, KY 40272-1203 |
Second Address | Louisville, KY 40272-1203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2012 |
Last Update Date | 07/12/2012 |