=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841749900
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DISCOVERY DEVELOPMENTAL SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2016
-----------------------------------------------------
Last Update Date | 09/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4934 BROWNSBORO RD
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40222-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-693-0379
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 CANTERBURY DR
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40220-1241
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OTR/L
-----------------------------------------------------
Name | MEGHAN MARISSA HILLERICH
-----------------------------------------------------
Credential | OTR/L
-----------------------------------------------------
Telephone | 502-693-0279
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 140249
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 105787
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 132478
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------