Facts
- Status
- A
- Credential
- COTA
- Type
- Individual
- Enumeration date
- 2006-11-08
- Last updated
- 2007-07-08
Licenses
- License KY
- KY-A3063
- License OH
- OTA 03327
Location
- Practice location
- 400 FARRELL DR
- City
- FT WRIGHT KY
- Postal code
- 410113785
- Phone
- 859-341-0777
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.