Individual
TRAVIS JASON PRENTICE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
159 SAINT MATTHEWS AVE, LOUISVILLE, KY 40207-3137
(502) 899-7105
Mailing address
6803 FEGENBUSH LN, LOUISVILLE, KY 40228-1371
(502) 744-7029
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
163137
KY
Other
Enumeration date
04/24/2024
Last updated
04/24/2024
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