Provider Demographics
NPI:1053445601
Name:WEST, JOLYNN S (MOT, OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JOLYNN
Middle Name:S
Last Name:WEST
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:JOLYNN
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:95 LANTERN WAY
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-9009
Mailing Address - Country:US
Mailing Address - Phone:505-917-1338
Mailing Address - Fax:
Practice Address - Street 1:401 LEWIS HARGETT CIR STE 120
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3564
Practice Address - Country:US
Practice Address - Phone:859-475-4305
Practice Address - Fax:877-804-4492
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY247536225X00000X
NM427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist