Provider Demographics
NPI:1003151622
Name:BRUTON, CONSTANCE ELAINE (OTR)
Entity Type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:ELAINE
Last Name:BRUTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7305 BETSY ROSS DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-1203
Mailing Address - Country:US
Mailing Address - Phone:502-749-2084
Mailing Address - Fax:502-271-3259
Practice Address - Street 1:7305 BETSY ROSS DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-1203
Practice Address - Country:US
Practice Address - Phone:502-749-2084
Practice Address - Fax:502-271-3259
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR0235225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist