MEDICARE: THOMAS SCOTT APPLEGATE OTR/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
1	225X00000X	Occupational Therapist	KY-R2507	KY

General Provider Information

NPI Number	:	1629302039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS SCOTT APPLEGATE OTR/L

Provider Business Mailing Address
First Line	:	220 LARCH LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-2004
Country	:	US
Telephone Number	:	859-948-0434
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 LARCH LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40511-2004
Country	:	US
Telephone Number	:	859-948-0434
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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