Healthcare Provider Details

I. General information

NPI: 1730331026
Provider Name (Legal Business Name): AMY LYNN GALES O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2008
Last Update Date: 02/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MIDLAND TRL SUITE 1 &2
SHELBYVILLE KY
40065-8141
US

IV. Provider business mailing address

1900 MIDLAND TRL SUITE 1 & 2
SHELBYVILLE KY
40065-8141
US

V. Phone/Fax

Practice location:
  • Phone: 502-633-1007
  • Fax: 502-437-0624
Mailing address:
  • Phone: 502-633-1007
  • Fax: 502-437-0624

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberKYR3206
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: