Individual
ALICIA KOTHEIMER EDMISTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
4121 SHELBYVILLE RD, SUITE 7, LOUISVILLE, KY 40207-3205
(502) 893-1380
Mailing address
200 DAISY LN, LOUISVILLE, KY 40243-1402
(502) 693-7037
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
KY-R5700
KY
Other
Enumeration date
03/05/2015
Last updated
07/28/2015
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