Basic Information
| Provider Information | |||||||||
| NPI: | 1205315918 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREGORY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | LEANN | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 53 CLOVERLEAF LN | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 426335097 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062784889 | ||||||||
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| Practice Location | |||||||||
| Address1: | 106 GOVER ST | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | KY | ||||||||
| PostalCode: | 425013332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6066798331 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2018 | ||||||||
| LastUpdateDate: | 08/13/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 243522 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.