Healthcare Provider Details

I. General information

NPI: 1518366525
Provider Name (Legal Business Name): TABETHA FROST OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TABETHA JONES

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 SPRINGWOOD DR
WAXHAW NC
28173-7229
US

IV. Provider business mailing address

704 SPRINGWOOD DR
WAXHAW NC
28173-7229
US

V. Phone/Fax

Practice location:
  • Phone: 859-200-5843
  • Fax:
Mailing address:
  • Phone: 859-200-5843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT.007563
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number133803
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14241
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: