MEDICARE: GWENDOLYN KAYE JONES OTR/L - LMT

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	225X00000X	Occupational Therapist	R3461	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11494494	OTHER	KY	CAQH

General Provider Information

NPI Number	:	1750322079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN KAYE JONES OTR/L - LMT

Provider Business Mailing Address
First Line	:	151 N EAGLE CREEK DR
Second Line	:	SUITE 400
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1889
Country	:	US
Telephone Number	:	859-264-8868
Fax Number	:	859-264-8878

Provider Business Practice Location Address
First Line	:	1010 MONARCH ST
Second Line	:	SUITE 110
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1497
Country	:	US
Telephone Number	:	859-296-1696
Fax Number	:	859-296-1676

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

Provider Enumeration Date	:	06/09/2006
Last Update Date	:	12/02/2015

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