Healthcare Provider Details

I. General information

NPI: 1639376569
Provider Name (Legal Business Name): LISA EVELYN BOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NORFLEET DR
SOMERSET KY
42501-1952
US

IV. Provider business mailing address

465 EAST LANGDON ROAD
SCIENCE HILL KY
42553
US

V. Phone/Fax

Practice location:
  • Phone: 600-678-5104
  • Fax: 606-677-1925
Mailing address:
  • Phone: 606-423-5464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberKY-A2666
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: