Individual
TONYA DANIELLE BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
625 CHESTNUT ST, BEREA, KY 40403-1550
(859) 582-0159
Mailing address
752 RICHMOND RD N, BEREA, KY 40403-1059
(859) 979-6999
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
267547
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
267547
OT LICENSE
—
Enumeration date
02/03/2021
Last updated
02/03/2021
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