Provider Demographics
NPI:1124803960
Name:REMLEY, SAGE (OT)
Entity type:Individual
Prefix:
First Name:SAGE
Middle Name:
Last Name:REMLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 HUTCHISON RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:KY
Mailing Address - Zip Code:40361-9005
Mailing Address - Country:US
Mailing Address - Phone:606-584-1169
Mailing Address - Fax:
Practice Address - Street 1:849 CLARKS RUN RD
Practice Address - Street 2:
Practice Address - City:MAYSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41056-8908
Practice Address - Country:US
Practice Address - Phone:606-584-1169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY286926225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY286926OtherKENTUCKY BOARD OF LICENSURE FOR OCCUPATIONAL THERAPY