Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | KY-R2889 | KY |
NPI | 1043462377 |
---|---|
Provider Name | Theresa Bradshaw |
First Address | Louisville, KY 40202-5700 |
Second Address | Louisville, KY 40202-5700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2008 |
Last Update Date | 17/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
KY-R2889 | LICENSE (01) | KY |