Healthcare Provider Details

I. General information

NPI: 1679383046
Provider Name (Legal Business Name): TUDOR PANTA OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 BISHOP LN STE 404
LOUISVILLE KY
40218-1922
US

IV. Provider business mailing address

1941 BISHOP LN STE 404
LOUISVILLE KY
40218-1922
US

V. Phone/Fax

Practice location:
  • Phone: 502-488-2753
  • Fax: 502-308-4725
Mailing address:
  • Phone: 502-488-2753
  • Fax: 502-308-4725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number246560
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number246560
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number246560
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number31006869A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number31006869A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number31006869A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number246560
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number31006869A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: