Healthcare Provider Details

I. General information

NPI: 1477124287
Provider Name (Legal Business Name): NATALIE CAROL BURNHAM MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE CAROL FORD

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LONE OAK RD
PADUCAH KY
42001-4444
US

IV. Provider business mailing address

493 CAMBRIDGE SHORES DR
GILBERTSVILLE KY
42044-8716
US

V. Phone/Fax

Practice location:
  • Phone: 270-575-2990
  • Fax:
Mailing address:
  • Phone: 270-970-2995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number271326
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: