MEDICARE: ASHLEY LYNN NOEL OTR

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	225XP0019X	Physical Rehabilitation Occupational Therapist	R4053	KY

General Provider Information

NPI Number	:	1962156075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY LYNN NOEL OTR

Provider Business Mailing Address
First Line	:	154 AHLENA WAY
Second Line	:
City	:	SPRINGFIELD
State	:	KY
Zip	:	40069-9563
Country	:	US
Telephone Number	:	859-805-0894
Fax Number	:

Provider Business Practice Location Address
First Line	:	2625 BARDSTOWN RD
Second Line	:
City	:	ST CATHARINE
State	:	KY
Zip	:	40061-9435
Country	:	US
Telephone Number	:	859-336-3974
Fax Number	:

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

Provider Enumeration Date	:	02/08/2022
Last Update Date	:	02/08/2022

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