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General NPI Number Information
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NPI Number | 1174106728
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Entity Type | Individual
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Provider Name | KELSEY NICOLE HODGE
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Gender | Female
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Dates
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Enumeration Date | 05/02/2021
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 303 N HURSTBOURNE PKWY
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City | LOUISVILLE
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State | KY
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Zip | 40222-5185
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Country | US
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Telephone | 800-335-1060
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Fax |
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Provider Business Mailing Address
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Address Line | 4115 SMITH RD APT 2
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City | CINCINNATI
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State | OH
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Zip | 45212-4164
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Country | US
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Telephone | 502-619-3210
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OT010854
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License Number State | OH
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