Healthcare Provider Details

I. General information

NPI: 1346687332
Provider Name (Legal Business Name): THERAPLACE LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2013
Last Update Date: 03/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4121 SHELBYVILLE RD SUITE 7
LOUISVILLE KY
40207-3205
US

IV. Provider business mailing address

4121 SHELBYVILLE RD SUITE 7
LOUISVILLE KY
40207-3205
US

V. Phone/Fax

Practice location:
  • Phone: 502-893-1380
  • Fax:
Mailing address:
  • Phone: 150-289-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JILL COX-WOODALL
Title or Position: OCCUPATIONAL THERAPIST
Credential: M.S., OTR/L
Phone: 502-494-5732