Provider Demographics
NPI:1326323320
Name:SPURLOCK, TRAVIS (OT)
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:SPURLOCK
Suffix:
Gender:M
Credentials:OT
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 1711
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1711
Mailing Address - Country:US
Mailing Address - Phone:606-436-5644
Mailing Address - Fax:
Practice Address - Street 1:100 HIGHWAY 15 S STE 136
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339-8636
Practice Address - Country:US
Practice Address - Phone:606-693-9644
Practice Address - Fax:606-693-9643
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR1886225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist