Healthcare Provider Details

I. General information

NPI: 1659906253
Provider Name (Legal Business Name): SOLICITY C MOUNTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2020
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 HOSPITAL DR
SOUTH WILLIAMSON KY
41503-4072
US

IV. Provider business mailing address

260 HOSPITAL DR
SOUTH WILLIAMSON KY
41503-4072
US

V. Phone/Fax

Practice location:
  • Phone: 606-237-1460
  • Fax:
Mailing address:
  • Phone: 606-237-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number170564
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: