Provider Demographics
NPI:1366718843
Name:DOWNEY, NANCY M (COTA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:DOWNEY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 N HITE AVE
Mailing Address - Street 2:APT 9
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1278
Mailing Address - Country:US
Mailing Address - Phone:270-484-6308
Mailing Address - Fax:
Practice Address - Street 1:310 N HITE AVE
Practice Address - Street 2:APT 9
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1278
Practice Address - Country:US
Practice Address - Phone:270-484-6308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA5077222Q00000X
IN99045801A222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYA5077OtherOTA CERTIFICATION
IN99045801AOtherOTA CERTIFICATION FOR IN