Provider Demographics
NPI:1336687169
Name:CASEY PEDIATRIC THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CASEY PEDIATRIC THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:859-333-0819
Mailing Address - Street 1:613 DOVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-7525
Mailing Address - Country:US
Mailing Address - Phone:859-333-0819
Mailing Address - Fax:859-972-0830
Practice Address - Street 1:613 DOVE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-7525
Practice Address - Country:US
Practice Address - Phone:859-333-0819
Practice Address - Fax:859-972-0830
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency