Healthcare Provider Details

I. General information

NPI: 1588047666
Provider Name (Legal Business Name): BUECHEL REHABILITATION AND OCCUPATIONAL THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 BARDSTOWN RD STE 101A
LOUISVILLE KY
40218-3292
US

IV. Provider business mailing address

4113 BARDSTOWN RD STE 101A
LOUISVILLE KY
40218-3292
US

V. Phone/Fax

Practice location:
  • Phone: 502-491-0492
  • Fax: 502-749-5194
Mailing address:
  • Phone: 502-491-0492
  • Fax: 502-749-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number StateKY

VIII. Authorized Official

Name: MRS. FANNIE L MILLER
Title or Position: PRESIDENT
Credential:
Phone: 502-491-0492