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NPI Code Detail

MEDICARE: MS. MADISON NICOLE MITCHELL OT R/L

MEDICARE: MS. MADISON NICOLE MITCHELL OT R/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist245122KY

General Provider Information

NPI Number : 1356819585
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MADISON NICOLE MITCHELL OT R/L
Provider Business Mailing Address
First Line : 2000 MAIN ST
Second Line :
City : PARIS
State : KY
Zip : 40361-1149
Country : US
Telephone Number : 859-987-5750
Fax Number :
Provider Business Practice Location Address
First Line : 2000 MAIN ST
Second Line :
City : PARIS
State : KY
Zip : 40361-1149
Country : US
Telephone Number : 859-987-5750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2018
Last Update Date : 11/06/2018

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