Healthcare Provider Details

I. General information

NPI: 1700911641
Provider Name (Legal Business Name): BELLADELLA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
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 43952
LOUISVILLE KY
40253-0952
US

V. Phone/Fax

Practice location:
  • Phone: 502-468-7626
  • Fax:
Mailing address:
  • Phone: 502-387-9079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR3673
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR3676
License Number StateKY

VIII. Authorized Official

Name: ASHLEY MARIE BOWLES
Title or Position: OCCUPATIONAL THERAPIST
Credential: MSOT OTRL
Phone: 502-387-9079