Individual
KELLEY BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
825 S 6TH ST, LOUISVILLE, KY 40203-2123
(502) 568-1000
(502) 568-1015
Mailing address
825 S 6TH ST, LOUISVILLE, KY 40203-2123
(502) 568-1000
(502) 568-1015
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
A2664
KY
Other
Enumeration date
05/15/2008
Last updated
05/15/2008
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