Provider Demographics
NPI:1588047666
Name:BUECHEL REHABILITATION AND OCCUPATIONAL THERAPY CENTER
Entity type:Organization
Organization Name:BUECHEL REHABILITATION AND OCCUPATIONAL THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FANNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-491-0492
Mailing Address - Street 1:4113 BARDSTOWN RD STE 101A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-3292
Mailing Address - Country:US
Mailing Address - Phone:502-491-0492
Mailing Address - Fax:502-749-5194
Practice Address - Street 1:4113 BARDSTOWN RD STE 101A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-3292
Practice Address - Country:US
Practice Address - Phone:502-491-0492
Practice Address - Fax:502-749-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-07
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization