MEDICARE: WILLIAM OFFUTT PETTIT

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
1	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1548801087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM OFFUTT PETTIT

Provider Business Mailing Address
First Line	:	2004 BLAIRMORE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-2435
Country	:	US
Telephone Number	:	859-230-9578
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 BLAIRMORE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40502-2435
Country	:	US
Telephone Number	:	859-230-9578
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	10/07/2019

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Directions to “ WILLIAM OFFUTT PETTIT ” Practice Location

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