Provider Demographics
NPI:1497740583
Name:WILLOUGHBY, JASON ALEXANDER (MHS, OTR/L, CHT)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALEXANDER
Last Name:WILLOUGHBY
Suffix:
Gender:M
Credentials:MHS, OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 HIGHWAY 45 N
Mailing Address - Street 2:SUITE 400
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1320
Mailing Address - Country:US
Mailing Address - Phone:859-264-8866
Mailing Address - Fax:859-264-1167
Practice Address - Street 1:151 N EAGLE CREEK DR
Practice Address - Street 2:SUITE 400
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1889
Practice Address - Country:US
Practice Address - Phone:859-264-8866
Practice Address - Fax:859-264-1167
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2268225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000600569OtherBCBS FOR LHT
KY000000600569OtherBCBS FOR LHT
KY00890001Medicare PIN
KYK023730Medicare Oscar/Certification