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General NPI Number Information
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NPI Number | 1407019169
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Entity Type | Individual
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Provider Name | GINA A. ROBERTS OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 680 S 4TH ST
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City | LOUISVILLE
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State | KY
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Zip | 40202-2407
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Country | US
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Telephone | 502-596-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CASTLEWOOD DR
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City | RICHMOND
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State | KY
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Zip | 40475-8860
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Country | US
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Telephone | 859-893-0921
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | R1038
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License Number State | KY
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