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General NPI Number Information
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NPI Number | 1184052920
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Entity Type | Organization
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Legal Business Name | LIFE SKILLS OCCUPATIONAL THERAPY
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Dates
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Enumeration Date | 10/14/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 308 W MARKET ST
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City | LEITCHFIELD
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State | KY
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Zip | 42754-1265
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Country | US
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Telephone | 270-589-1292
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7
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City | LEITCHFIELD
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State | KY
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Zip | 42755-0007
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DANA R EARLEY
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Credential | MSOT, OTR/L
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Telephone | 270-589-1292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | R4652
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License Number State | KY
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