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General NPI Number Information
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NPI Number | 1750581443
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Entity Type | Individual
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Provider Name | JENNY MUDD NEEL MSOT, OTR/L
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Gender | Female
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 704 BLOOMFIELD RD
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City | BARDSTOWN
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State | KY
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Zip | 40004-2025
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Country | US
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Telephone | 502-331-5478
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Fax | 502-348-9825
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Provider Business Mailing Address
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Address Line | 120 TRINITY CEMETERY LOOP
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City | BARDSTOWN
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State | KY
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Zip | 40004-7914
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Country | US
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Telephone | 502-348-5798
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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 | KY-R3653
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 134493
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License Number State | KY
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