Provider Demographics
NPI:1326634163
Name:RICKARD, EMILY ANN (COTA/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:RICKARD
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 BEENY RD
Mailing Address - Street 2:
Mailing Address - City:MANITOU
Mailing Address - State:KY
Mailing Address - Zip Code:42436-9633
Mailing Address - Country:US
Mailing Address - Phone:270-871-9408
Mailing Address - Fax:
Practice Address - Street 1:313 BEENY RD
Practice Address - Street 2:
Practice Address - City:MANITOU
Practice Address - State:KY
Practice Address - Zip Code:42436-9633
Practice Address - Country:US
Practice Address - Phone:270-871-9408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY136738224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant