Healthcare Provider Details

I. General information

NPI: 1356426191
Provider Name (Legal Business Name): DENNIS MICHAEL FLICKINGER OT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 CRESTVIEW DR
HORSE CAVE KY
42749-1212
US

IV. Provider business mailing address

313 CRESTVIEW DR
HORSE CAVE KY
42749-1212
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-5473
  • Fax: 270-786-1655
Mailing address:
  • Phone: 270-786-5473
  • Fax: 270-786-1655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR1107
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: