Healthcare Provider Details

I. General information

NPI: 1568619377
Provider Name (Legal Business Name): REBECCA T THOMPSON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA S TAYLOR OT

II. Dates (important events)

Enumeration Date: 08/22/2008
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 EASTERN BY-PASS
RICHMOND KY
40475-2325
US

IV. Provider business mailing address

P O BOX 911148
LEXINGTON KY
40591-1148
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-6334
  • Fax: 859-623-6336
Mailing address:
  • Phone: 859-278-2121
  • Fax: 859-276-1649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR3548
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: