Provider Demographics
NPI:1063614055
Name:GARRETT, VICTORIA LEDARLENE (MS OTR L)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LEDARLENE
Last Name:GARRETT
Suffix:
Gender:F
Credentials:MS OTR L
Other - Prefix:MISS
Other - First Name:VICTORIA
Other - Middle Name:LE-DARLENE
Other - Last Name:RAGSDALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS OTR L
Mailing Address - Street 1:10400 LEDDENTON WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241
Mailing Address - Country:US
Mailing Address - Phone:502-749-9434
Mailing Address - Fax:
Practice Address - Street 1:800 ZORN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1433
Practice Address - Country:US
Practice Address - Phone:502-287-4513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3193225X00000X
IN31004224A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist