Healthcare Provider Details

I. General information

NPI: 1881372290
Provider Name (Legal Business Name): MADISON KUZNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 SHELBYVILLE RD
LOUISVILLE KY
40243-1040
US

IV. Provider business mailing address

6803 BLACKHORSE DR
LOUISVILLE KY
40291-3065
US

V. Phone/Fax

Practice location:
  • Phone: 502-245-3774
  • Fax:
Mailing address:
  • Phone: 502-386-7350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number282733
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: