Provider Demographics
NPI:1467638858
Name:NUNN, DANA SMITH (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:SMITH
Last Name:NUNN
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:MICHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, OTR/L
Mailing Address - Street 1:10116 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3948
Mailing Address - Country:US
Mailing Address - Phone:502-995-8844
Mailing Address - Fax:502-995-8842
Practice Address - Street 1:9616 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3473
Practice Address - Country:US
Practice Address - Phone:502-995-8844
Practice Address - Fax:502-995-8842
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR3393225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist