=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275149353
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN KING
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2020
-----------------------------------------------------
Last Update Date | 09/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 NEWCOMB AVE
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40456-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 606-256-2195
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4826 SPIRO RD
-----------------------------------------------------
City | MOUNT VERNON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40456-8543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 134089
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------