Healthcare Provider Details

I. General information

NPI: 1154500155
Provider Name (Legal Business Name): MARJORIE AQUINO VILO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16700 GLEN LAKES DRIVE
LOUISVILLE KY
40245-5313
US

IV. Provider business mailing address

16700 GLEN LAKES DRIVE
LOUISVILLE KY
40245-5313
US

V. Phone/Fax

Practice location:
  • Phone: 502-370-7333
  • Fax: 502-384-4087
Mailing address:
  • Phone: 502-370-7333
  • Fax: 502-384-4087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKY-R3543
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberKY-R3543
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: