Provider Demographics
NPI:1376142836
Name:KING, EMMA GRACE (MT-BC)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:GRACE
Last Name:KING
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 TURKEY FOOT RD APT 4
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-7007
Mailing Address - Country:US
Mailing Address - Phone:270-245-7232
Mailing Address - Fax:
Practice Address - Street 1:465 ROSE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40506-7007
Practice Address - Country:US
Practice Address - Phone:270-245-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
16061225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist