Healthcare Provider Details

I. General information

NPI: 1942454939
Provider Name (Legal Business Name): ALICIA KATHERINE DRAKE HAMILTON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 05/09/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 RUCCIO WAY
LEXINGTON KY
40503-3662
US

IV. Provider business mailing address

90 HOWARD DR
SHELBYVILLE KY
40065-8138
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1007
  • Fax: 502-805-1511
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-805-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number131378
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number131378
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: