Provider Demographics
NPI:1003152745
Name:CARPENTER, VANESSA GAY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:GAY
Last Name:CARPENTER
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 1:1444 PONDSVILLE KEPLER RD
Mailing Address - Street 2:
Mailing Address - City:SMITHS GROVE
Mailing Address - State:KY
Mailing Address - Zip Code:42171-6221
Mailing Address - Country:US
Mailing Address - Phone:270-799-9703
Mailing Address - Fax:
Practice Address - Street 1:1381 CAMPBELL LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1049
Practice Address - Country:US
Practice Address - Phone:270-843-0587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA3293224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant