Individual
MEGAN JADE TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
116 S COMMONWEALTH AVE, CORBIN, KY 40701-6408
(606) 258-2500
Mailing address
12710 TOWNEPARK WAY STE 1000, LOUISVILLE, KY 40243-1596
(502) 254-4200
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
273399
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185232
—
KY
Enumeration date
01/08/2022
Last updated
01/08/2022
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