MEDICARE: ALETHEA CHRISTINE COFFEE IECE CERTIFIED

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1932805199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALETHEA CHRISTINE COFFEE IECE CERTIFIED

Provider Business Mailing Address
First Line	:	143 PLANTATION DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8310
Country	:	US
Telephone Number	:	502-321-1069
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 PLANTATION DR
Second Line	:
City	:	SHELBYVILLE
State	:	KY
Zip	:	40065-8310
Country	:	US
Telephone Number	:	502-321-1069
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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Directions to “ ALETHEA CHRISTINE COFFEE IECE CERTIFIED” Practice Location

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