Healthcare Provider Details

I. General information

NPI: 1013636935
Provider Name (Legal Business Name): STILLWATERS OCCUPATIONAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310B S KEENELAND DR
RICHMOND KY
40475-3228
US

IV. Provider business mailing address

310B S KEENELAND DR
RICHMOND KY
40475-3228
US

V. Phone/Fax

Practice location:
  • Phone: 252-333-8543
  • Fax:
Mailing address:
  • Phone: 252-333-8543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TIMOTHY SEIGH
Title or Position: BUSINESS ADMINISTRATOR
Credential:
Phone: 252-333-8543