Healthcare Provider Details

I. General information

NPI: 1740225895
Provider Name (Legal Business Name): CHRISTIE LYNN HIGDON OT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: CHRISTIE TIMBERLAKE

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 EASTERN BY-PASS
RICHMOND KY
40475
US

IV. Provider business mailing address

PO 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: 859-276-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR2656
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: