Provider Demographics
NPI:1104543552
Name:OSBORNE, DOUGLAS ALLEN (OT/L)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:ALLEN
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:OT/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 CAMELLIA DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3221
Mailing Address - Country:US
Mailing Address - Phone:185-935-1013
Mailing Address - Fax:
Practice Address - Street 1:1013 CAMELLIA DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3221
Practice Address - Country:US
Practice Address - Phone:185-935-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY135420225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist