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General NPI Number Information
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NPI Number | 1083832000
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Entity Type | Organization
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Legal Business Name | THE SWINGING BRIDGE, LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 133 DORIS CT
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9548
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Country | US
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Telephone | 270-737-4556
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Fax |
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Provider Business Mailing Address
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Address Line | 133 DORIS CT
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-9548
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Country | US
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Telephone | 270-737-4556
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA ANN SHEARER
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Credential | OTL
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Telephone | 270-737-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | KY-R0740
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License Number State | KY
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