Healthcare Provider Details

I. General information

NPI: 1770035164
Provider Name (Legal Business Name): ASHLEY MCKINNEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2016
Last Update Date: 11/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9912 SPRING RIDGE DR
LOUISVILLE KY
40223-2877
US

IV. Provider business mailing address

10802 WORTHINGTON LN
PROSPECT KY
40059-9588
US

V. Phone/Fax

Practice location:
  • Phone: 502-442-4005
  • Fax:
Mailing address:
  • Phone: 502-553-6232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number170755
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: