Organization
BLUEGRASS THERAPY PLLC
Active
Organization
BLUEGRASS THERAPY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARA O CHILDERS (CO-OWNER)
(606) 791-7435
Entity
Organization
Contact information
Practice address
1191 S LAKE DR, PRESTONSBURG, KY 41653-1349
(606) 791-7435
Mailing address
1191 S LAKE DR, PRESTONSBURG, KY 41653-1349
(606) 791-7435
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
07/29/2019
Last updated
12/09/2019
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