Individual
JENNIFER THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4200 BROWNS LN, LOUISVILLE, KY 40220-1523
(502) 459-8900
Mailing address
3507 STONY BROOK DR, LOUISVILLE, KY 40299-1541
(502) 494-4246
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
R1290
KY
Other
Enumeration date
11/27/2013
Last updated
11/27/2013
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