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General NPI Number Information
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NPI Number | 1841642675
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Entity Type | Organization
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Legal Business Name | TRACI PURVIS DBA THERAPY BUILDERS
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Dates
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Enumeration Date | 07/05/2016
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Last Update Date | 07/05/2016
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Provider Practice Location Address
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Address Line | 4211 SHERMAN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40213-1846
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Country | US
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Telephone | 502-302-9024
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Fax | 502-470-7318
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Provider Business Mailing Address
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Address Line | 4211 SHERMAN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40213-1846
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Country | US
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Telephone | 502-302-9024
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Fax | 502-470-7318
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | TRACI LYNN PURVIS
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Credential | OTR/L
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Telephone | 502-302-9024
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | KY-R2744
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License Number State | KY
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