Provider Demographics
NPI:1194849018
Name:BAUSCH, DINAH GALE (IECE,MASE)
Entity type:Individual
Prefix:
First Name:DINAH
Middle Name:GALE
Last Name:BAUSCH
Suffix:
Gender:F
Credentials:IECE,MASE
Other - Prefix:
Other - First Name:DINAH
Other - Middle Name:GALE
Other - Last Name:SAGRACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IECE, MASE
Mailing Address - Street 1:400 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1428
Mailing Address - Country:US
Mailing Address - Phone:859-481-2672
Mailing Address - Fax:859-554-2725
Practice Address - Street 1:400 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1428
Practice Address - Country:US
Practice Address - Phone:859-481-2672
Practice Address - Fax:859-554-2725
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist