Healthcare Provider Details

I. General information

NPI: 1740606755
Provider Name (Legal Business Name): KAY CONSTABLE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

533 DAYTON ST
HAMILTON OH
45011-3455
US

IV. Provider business mailing address

533 DAYTON ST P.O. BOX 627
HAMILTON OH
45011-3455
US

V. Phone/Fax

Practice location:
  • Phone: 513-887-5014
  • Fax:
Mailing address:
  • Phone: 513-887-5014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number991
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: