Healthcare Provider Details

I. General information

NPI: 1043669146
Provider Name (Legal Business Name): UK PEDIATRIC THERAPIES AT CHILD DEVELOPMENT CENTER OF THE BLUEGRASS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2016
Last Update Date: 02/14/2024
Certification Date: 02/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 ALUMNI DR STE 104
LEXINGTON KY
40503-1601
US

IV. Provider business mailing address

2333 ALUMNI PARK PLZ STE 200
LEXINGTON KY
40517-4012
US

V. Phone/Fax

Practice location:
  • Phone: 859-218-1684
  • Fax: 859-257-0284
Mailing address:
  • Phone: 859-257-7910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG COLLINS
Title or Position: SR VP HEALTH AFFAIRS / CFO
Credential:
Phone: 859-257-1773