Healthcare Provider Details

I. General information

NPI: 1881044675
Provider Name (Legal Business Name): SKILLZ 4 LIFE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 06/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3814 GREENWICH RD
LOUISVILLE KY
40218-1616
US

IV. Provider business mailing address

3814 GREENWICH RD
LOUISVILLE KY
40218-1616
US

V. Phone/Fax

Practice location:
  • Phone: 502-855-1271
  • Fax:
Mailing address:
  • Phone: 502-855-1271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR5089
License Number StateKY

VIII. Authorized Official

Name: MS. MARLEETA HARRIS
Title or Position: PRESIDENT/ OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 502-855-1271