=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932248861
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELA FULKERSON FOLCZYK OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2007
-----------------------------------------------------
Last Update Date | 06/02/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 856 HENDERSON DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40515-6464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-539-2844
-----------------------------------------------------
Fax | 859-272-7311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 856 HENDERSON DR
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40515-6464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-539-2844
-----------------------------------------------------
Fax | 859-272-7311
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 136514
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | R2280
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------