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NPI Code Detail

MEDICARE: AUTUMN BAY

MEDICARE: AUTUMN BAY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational TherapistBOTOCT00220887KY

General Provider Information

NPI Number : 1275985236
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUTUMN BAY
Provider Business Mailing Address
First Line : 100 W RAMSEY ST
Second Line :
City : DAWSON SPRINGS
State : KY
Zip : 42408-1739
Country : US
Telephone Number : 616-975-5092
Fax Number :
Provider Business Practice Location Address
First Line : 100 W RAMSEY ST
Second Line :
City : DAWSON SPRINGS
State : KY
Zip : 42408-1739
Country : US
Telephone Number : 616-975-5092
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/01/2016
Last Update Date : 07/01/2016

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Directions to “ AUTUMN BAY ” Practice Location

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