Healthcare Provider Details

I. General information

NPI: 1124219803
Provider Name (Legal Business Name): MARSHA DAWN SPAIN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2582 CERULEAN RD
CADIZ KY
42211-9605
US

IV. Provider business mailing address

890 BILLY GOAT HILL RD
HOPKINSVILLE KY
42240-1146
US

V. Phone/Fax

Practice location:
  • Phone: 270-522-3236
  • Fax: 270-522-0825
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3578
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberR3578
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: