Healthcare Provider Details

I. General information

NPI: 1912256827
Provider Name (Legal Business Name): HOP SKIP AND A JUMP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 WINDSOR PATH SUITE 1
GEORGETOWN KY
40324-9617
US

IV. Provider business mailing address

105 WINDSOR PATH SUITE 1
GEORGETOWN KY
40324-9617
US

V. Phone/Fax

Practice location:
  • Phone: 502-570-2337
  • Fax: 502-570-2338
Mailing address:
  • Phone: 502-570-2337
  • Fax: 502-570-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANN L BEEBE
Title or Position: OTR/L
Credential:
Phone: 502-570-2337