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General NPI Number Information
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NPI Number | 1669915609
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Entity Type | Organization
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Legal Business Name | ENERGIZED THERAPY
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Dates
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Enumeration Date | 11/23/2016
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Last Update Date | 11/23/2016
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Provider Practice Location Address
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Address Line | 702 PHILLIPS LANE
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City | CORBIN
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State | KY
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Zip | 40701
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Country | US
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Telephone | 330-687-8035
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 76
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City | TYNER
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State | KY
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Zip | 40486-0076
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Country | US
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Telephone | 330-687-8035
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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. MARGARET A WORLEY
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Credential | OTR/L
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Telephone | 330-687-8035
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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 | 136288
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License Number State | KY
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