Healthcare Provider Details

I. General information

NPI: 1346494267
Provider Name (Legal Business Name): FORWARD MOTION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 GOSHEN LN
GOSHEN KY
40026-9514
US

IV. Provider business mailing address

PO BOX 302
GOSHEN KY
40026-0302
US

V. Phone/Fax

Practice location:
  • Phone: 502-228-4040
  • Fax: 502-290-0005
Mailing address:
  • Phone: 502-228-4040
  • Fax: 502-290-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3676
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5036
License Number StateKY

VIII. Authorized Official

Name: ASHLEY MARIE BOWLES
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 502-387-9079