Healthcare Provider Details

I. General information

NPI: 1427255645
Provider Name (Legal Business Name): MAGGIE HOARD MSOTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 ISLAND FORD RD.
MADISONVILLE KY
42431-4243
US

IV. Provider business mailing address

176 ILSLEY CHURCH SPUR
DAWSON SPRINGS KY
42408
US

V. Phone/Fax

Practice location:
  • Phone: 270-825-0166
  • Fax:
Mailing address:
  • Phone: 270-669-0266
  • Fax: 270-475-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKY-R3499
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: