Healthcare Provider Details

I. General information

NPI: 1598986606
Provider Name (Legal Business Name): EBONY BOND OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

970 S 4TH ST
LOUISVILLE KY
40203-3250
US

IV. Provider business mailing address

970 S 4TH ST
LOUISVILLE KY
40203-3250
US

V. Phone/Fax

Practice location:
  • Phone: 502-650-4120
  • Fax: 502-780-6700
Mailing address:
  • Phone: 502-650-4120
  • Fax: 502-780-6700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKY-R3450
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number132307
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: