Healthcare Provider Details

I. General information

NPI: 1427244052
Provider Name (Legal Business Name): KATHERINE A BUSH OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE A MATTINGLY

II. Dates (important events)

Enumeration Date: 09/18/2007
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 LONG RUN RD
LOUISVILLE KY
40245-4334
US

IV. Provider business mailing address

1410 LONG RUN RD
LOUISVILLE KY
40245-4334
US

V. Phone/Fax

Practice location:
  • Phone: 502-244-8011
  • Fax: 502-244-6631
Mailing address:
  • Phone: 502-244-8011
  • Fax: 502-244-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberR3731
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: