Healthcare Provider Details

I. General information

NPI: 1578805412
Provider Name (Legal Business Name): NICOLE LOESCHKE MINTON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 SECOND ST
SOMERSET KY
42501-2390
US

IV. Provider business mailing address

226 SLAVEY RD
SOMERSET KY
42501-4704
US

V. Phone/Fax

Practice location:
  • Phone: 606-677-1166
  • Fax: 606-677-0693
Mailing address:
  • Phone: 606-425-2714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number134214
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number134214
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: