Healthcare Provider Details

I. General information

NPI: 1386859437
Provider Name (Legal Business Name): MILBURN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 09/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 TIMBER RIDGE DR STE 201
PROSPECT KY
40059-8151
US

IV. Provider business mailing address

5920 TIMBER RIDGE DR STE 201
PROSPECT KY
40059-8151
US

V. Phone/Fax

Practice location:
  • Phone: 502-451-2142
  • Fax: 502-451-2740
Mailing address:
  • Phone: 502-451-2142
  • Fax: 502-451-2740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1904
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1904
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: SANDRA MEADOWS MILBURN
Title or Position: PRESIDENT
Credential: PT
Phone: 502-451-2142