Healthcare Provider Details

I. General information

NPI: 1164209607
Provider Name (Legal Business Name): BREATH AND BALANCE PEDIATRIC THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E REYNOLDS RD STE 3
LEXINGTON KY
40517-1251
US

IV. Provider business mailing address

600 CARPENTER CREEK RD
PARKSVILLE KY
40464-9090
US

V. Phone/Fax

Practice location:
  • Phone: 606-282-3503
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AIMEE LEE DAVIS
Title or Position: OWNER, OCCUPATIONAL THERAPIST
Credential: MS OTR/L CIMC
Phone: 606-282-3503