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NPI Code Detail

MEDICARE: MATTHEW D BYNUM OTR/L

MEDICARE: MATTHEW D BYNUM OTR/L
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 Therapist162060KY

General Provider Information

NPI Number : 1346639606
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW D BYNUM OTR/L
Provider Business Mailing Address
First Line : 2008 KENILWORTH PL
Second Line :
City : LOUISVILLE
State : KY
Zip : 40205-1514
Country : US
Telephone Number : 502-472-1341
Fax Number :
Provider Business Practice Location Address
First Line : 3012 EASTPOINT PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-4185
Country : US
Telephone Number : 502-245-0767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2015
Last Update Date : 12/03/2025

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