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General NPI Number Information
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NPI Number | 1679930192
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Entity Type | Individual
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Provider Name | ANNA JAYNE OTR/L
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Gender | Female
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 100 SPARKS AVE
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-1004
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Country | US
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Telephone | 859-885-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 231 CLEO AVE
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City | LANCASTER
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State | KY
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Zip | 40444-9500
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Country | US
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Telephone | 859-548-5314
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | R2689
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License Number State | KY
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