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General NPI Number Information
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NPI Number | 1023246675
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Entity Type | Organization
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Legal Business Name | KENTUCKY ORTHOTIC PROVIDERS, LLC
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Dates
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Enumeration Date | 06/22/2009
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 800 STONE CREEK PKWY SUITE 1
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City | LOUISVILLE
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State | KY
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Zip | 40223-5366
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Country | US
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Telephone | 502-649-5468
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99042
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City | LOUISVILLE
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State | KY
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Zip | 40269-0042
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Country | US
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Telephone | 502-649-5468
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. KURT ALAN REIBLING
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Credential | BSME, MBA
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Telephone | 502-649-5468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 0728233
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License Number State | KY
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