Provider Demographics
NPI:1386216596
Name:MOFFIT, BRITTANY NICOLE (OTA/L)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:NICOLE
Last Name:MOFFIT
Suffix:
Gender:F
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SAINT FRANCIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:KY
Mailing Address - Zip Code:40062-7013
Mailing Address - Country:US
Mailing Address - Phone:859-267-0166
Mailing Address - Fax:
Practice Address - Street 1:1155 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1401
Practice Address - Country:US
Practice Address - Phone:502-636-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171470225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY171470OtherKENTUCKY BOARD OF LICENSURE FOR OCCUPATIONAL THERAPY