Healthcare Provider Details

I. General information

NPI: 1376754838
Provider Name (Legal Business Name): LAURIE BOBYACK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 N TOLLIVER RD
MOREHEAD KY
40351-1347
US

IV. Provider business mailing address

404 STEPPING STONE LN
HILLSBORO KY
41049-8434
US

V. Phone/Fax

Practice location:
  • Phone: 606-784-7518
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3551
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: