=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376788877
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER HART MA, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2008
-----------------------------------------------------
Last Update Date | 04/09/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4121 SHELBYVILLE RD STE 7
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-3205
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-893-1380
-----------------------------------------------------
Fax | 502-893-1773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2501 TOP HILL RD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40206-2830
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-718-1512
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 132297
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------