Healthcare Provider Details

I. General information

NPI: 1881943579
Provider Name (Legal Business Name): TYLER P HENSON OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 RADIO PARK DR STE 1
RICHMOND KY
40475-2998
US

IV. Provider business mailing address

350 RADIO PARK DR STE 1
RICHMOND KY
40475-2998
US

V. Phone/Fax

Practice location:
  • Phone: 859-625-5986
  • Fax: 859-625-5987
Mailing address:
  • Phone: 859-625-5986
  • Fax: 859-625-5987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberR5339
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: