Individual
MRS. TINA L WAITS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
101 WINDSOR PATH, GEORGETOWN, KY 40324
(859) 422-4568
(859) 757-4649
Mailing address
3480 YORKSHIRE MEDICAL PARK, LEXINGTON, KY 40509
(859) 422-4568
(859) 757-4649
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
133079
KY
225X00000X
Occupational Therapist
R4758
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
133079
KY STATE LICENSE
KY
05
—
7100201870
—
KY
Enumeration date
06/12/2007
Last updated
11/12/2019
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