Healthcare Provider Details

I. General information

NPI: 1356063572
Provider Name (Legal Business Name): AMY RUTH SKINNER MS OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ZORN AVE
LOUISVILLE KY
40206-1433
US

IV. Provider business mailing address

11709 PARAMONT WAY
PROSPECT KY
40059-9075
US

V. Phone/Fax

Practice location:
  • Phone: 502-287-4513
  • Fax:
Mailing address:
  • Phone: 502-767-7412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number132219
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: