Provider Demographics
NPI:1235444142
Name:SAYLOR, JEREBETH GLENAE
Entity Type:Individual
Prefix:MRS
First Name:JEREBETH
Middle Name:GLENAE
Last Name:SAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JEREBETH
Other - Middle Name:GLENAE
Other - Last Name:LUCAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:HARROGATE
Mailing Address - State:TN
Mailing Address - Zip Code:37752-0165
Mailing Address - Country:US
Mailing Address - Phone:606-521-1135
Mailing Address - Fax:
Practice Address - Street 1:440 SAMS MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:606-521-1135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201123229222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist