Healthcare Provider Details

I. General information

NPI: 1598836207
Provider Name (Legal Business Name): AMANDA LEE EDSELL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9880 ANGIES WAY STE 100
LOUISVILLE KY
40241-2851
US

IV. Provider business mailing address

405 WOODED FALLS RD
LOUISVILLE KY
40243-2095
US

V. Phone/Fax

Practice location:
  • Phone: 502-339-6490
  • Fax: 502-339-6492
Mailing address:
  • Phone: 502-552-7255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberR3009
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: