Provider Demographics
NPI:1053849695
Name:SHOUSE, AMY C
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:SHOUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:FINCHVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40022-0093
Mailing Address - Country:US
Mailing Address - Phone:502-529-9825
Mailing Address - Fax:
Practice Address - Street 1:1040 US HIGHWAY 127 S
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4326
Practice Address - Country:US
Practice Address - Phone:502-875-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2017-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131001282224Z00000X
KY135112224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant