Organization
WILDERNESS TRACE CHILD DEVELOPMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LIBBY SUTTLES (EXECUTIVE DIRECTOR)
(859) 236-0878
Entity
Organization
Contact information
Practice address
409 STEWARTS LN N, DANVILLE, KY 40422-8825
(859) 236-0878
(859) 236-0878
Mailing address
409 STEWARTS LN N, DANVILLE, KY 40422-8825
(859) 236-0878
(859) 236-3570
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
251300000X
Local Education Agency (LEA)
354928
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00153
FIRST STEPS PROVIDER NUMB
KY
05
—
7100454490
—
KY
Enumeration date
05/21/2007
Last updated
05/10/2017
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