=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871748632
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAELIN PHYSICAL THERAPY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2008
-----------------------------------------------------
Last Update Date | 11/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2200 E PARRISH AVE STE 105 C
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-691-2699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2200 E PARRISH AVE STE 105 C
-----------------------------------------------------
City | OWENSBORO
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42303-1449
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 270-691-2699
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DONNA MARIE KAELIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 270-316-0859
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | 1006
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------