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General NPI Number Information
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NPI Number | 1679383046
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Entity Type | Individual
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Provider Name | TUDOR PANTA OTR
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Gender | Male
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 1941 BISHOP LN STE 404
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City | LOUISVILLE
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State | KY
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Zip | 40218-1922
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Country | US
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Telephone | 502-488-2753
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Fax | 502-308-4725
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Provider Business Mailing Address
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Address Line | 1941 BISHOP LN STE 404
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City | LOUISVILLE
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State | KY
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Zip | 40218-1922
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Country | US
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Telephone | 502-488-2753
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Fax | 502-308-4725
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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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 246560
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 246560
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 246560
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 225XH1200X
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Taxonomy Name | Hand Occupational Therapist
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License Number | 31006869A
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 31006869A
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License Number State | IN
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Taxonomy #6
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Taxonomy Code | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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License Number | 31006869A
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License Number State | IN
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Taxonomy #7
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Taxonomy Code | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | 246560
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License Number State | KY
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Taxonomy #8
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 31006869A
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License Number State | IN
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