Healthcare Provider Details

I. General information

NPI: 1942565163
Provider Name (Legal Business Name): SUSAN F STERN OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 CORPORATE DR STE 301
LEXINGTON KY
40503-5424
US

IV. Provider business mailing address

841 CORPORATE DR STE 301
LEXINGTON KY
40503-5424
US

V. Phone/Fax

Practice location:
  • Phone: 859-333-9312
  • Fax: 620-508-2008
Mailing address:
  • Phone: 859-224-2271
  • Fax: 859-224-4675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR3536
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number135463
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: