Individual
STACEY NORTHRUP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1053 LOVERS LN, BOWLING GREEN, KY 42103-7166
(502) 633-1007
Mailing address
90 HOWARD DR, SHELBYVILLE, KY 40065-8138
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
277012
KY
Other
Enumeration date
08/02/2022
Last updated
08/02/2022
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