Provider Demographics
NPI:1467618587
Name:BROUGHTON, CAREY ANN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:ANN
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 FREDERICA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6086
Mailing Address - Country:US
Mailing Address - Phone:270-926-2212
Mailing Address - Fax:270-926-2215
Practice Address - Street 1:3221 FREDERICA ST
Practice Address - Street 2:SUITE B
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6086
Practice Address - Country:US
Practice Address - Phone:270-926-2212
Practice Address - Fax:270-926-2215
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist