Healthcare Provider Details

I. General information

NPI: 1326701657
Provider Name (Legal Business Name): EMILY TAYLOR PORTER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N RACE ST
GLASGOW KY
42141-3454
US

IV. Provider business mailing address

469 DRAGWAY LN
CAMPBELLSVILLE KY
42718-9658
US

V. Phone/Fax

Practice location:
  • Phone: 270-651-4444
  • Fax:
Mailing address:
  • Phone: 270-403-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number273124
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: