Healthcare Provider Details

I. General information

NPI: 1720486012
Provider Name (Legal Business Name): DOVETAIL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 KNOX BLVD
RADCLIFF KY
40160-1514
US

IV. Provider business mailing address

PO BOX 558
RADCLIFF KY
40159-0558
US

V. Phone/Fax

Practice location:
  • Phone: 270-351-2224
  • Fax: 502-849-1279
Mailing address:
  • Phone: 270-351-2224
  • Fax: 502-849-1279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberBOTOCT
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberBOTOCT00210728
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberBOTOCT00210728
License Number StateKY

VIII. Authorized Official

Name: ROBIN CAROL ABBOTT
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: OTR/L
Phone: 270-351-2224