Provider Demographics
NPI:1518447259
Name:BULLOCK, KARLA KAY (OTR/L)
Entity Type:Individual
Prefix:MISS
First Name:KARLA
Middle Name:KAY
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1488 SPIRO RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-6316
Mailing Address - Country:US
Mailing Address - Phone:606-308-2105
Mailing Address - Fax:
Practice Address - Street 1:1488 SPIRO RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:KY
Practice Address - Zip Code:40456-6316
Practice Address - Country:US
Practice Address - Phone:606-308-2105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY132789225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical RehabilitationGroup - Single Specialty