Healthcare Provider Details

I. General information

NPI: 1356336465
Provider Name (Legal Business Name): ROBERT BRIAN NEVILLE OTR/L, CHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-1889
US

IV. Provider business mailing address

151 N EAGLE CREEK DR SUITE 400
LEXINGTON KY
40509-1889
US

V. Phone/Fax

Practice location:
  • Phone: 859-264-8866
  • Fax: 859-264-1167
Mailing address:
  • Phone: 859-264-8866
  • Fax: 859-264-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberR2216
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: