Healthcare Provider Details

I. General information

NPI: 1912386343
Provider Name (Legal Business Name): INDEPENDENCE AT HEART LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2015
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13003 LARKSPUR LN
PROSPECT KY
40059-9714
US

IV. Provider business mailing address

13003 LARKSPUR LN
PROSPECT KY
40059-9714
US

V. Phone/Fax

Practice location:
  • Phone: 502-387-4254
  • Fax:
Mailing address:
  • Phone: 502-387-4254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberR0033
License Number StateKY

VIII. Authorized Official

Name: MS. KERRIE J ANTHONY
Title or Position: OWNER/ MANAGER
Credential: OTR/L
Phone: 502-387-4254