Provider Demographics
NPI:1245566371
Name:FOLLSTAEDT, MIKAL ERIN (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:MIKAL
Middle Name:ERIN
Last Name:FOLLSTAEDT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 EDGELAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-1420
Mailing Address - Country:US
Mailing Address - Phone:502-384-4201
Mailing Address - Fax:502-384-4201
Practice Address - Street 1:2013 EDGELAND AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1420
Practice Address - Country:US
Practice Address - Phone:502-384-4201
Practice Address - Fax:502-384-4201
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4343225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist