Healthcare Provider Details

I. General information

NPI: 1821780768
Provider Name (Legal Business Name): RACHEL LEAH TAYLOR MARTIN LPAT 10-26-2015
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHEL L TAYLOR MARTIN

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8011 NEW LA GRANGE RD STE 7
LYNDON KY
40222-4781
US

IV. Provider business mailing address

8011 NEW LA GRANGE RD STE 7
LYNDON KY
40222-4781
US

V. Phone/Fax

Practice location:
  • Phone: 502-744-7490
  • Fax:
Mailing address:
  • Phone: 502-744-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number166620
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: