Healthcare Provider Details

I. General information

NPI: 1245814359
Provider Name (Legal Business Name): LARA HOTCHKISS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 05/06/2021
Certification Date: 04/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 ROCKINGHAM PATH
SADIEVILLE KY
40370-8302
US

IV. Provider business mailing address

121 ROCKINGHAM PATH
SADIEVILLE KY
40370-8302
US

V. Phone/Fax

Practice location:
  • Phone: 217-899-5521
  • Fax:
Mailing address:
  • Phone: 217-899-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA02956
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: