Provider Demographics
NPI:1568107431
Name:SEBASTIAN, KIRBY LEE
Entity Type:Individual
Prefix:
First Name:KIRBY
Middle Name:LEE
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIRBY
Other - Middle Name:LEE
Other - Last Name:SEBASTIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:HARNED
Mailing Address - State:KY
Mailing Address - Zip Code:40144-0008
Mailing Address - Country:US
Mailing Address - Phone:270-617-8520
Mailing Address - Fax:
Practice Address - Street 1:201 S HIGHWAY 259
Practice Address - Street 2:
Practice Address - City:HARNED
Practice Address - State:KY
Practice Address - Zip Code:40144-4014
Practice Address - Country:US
Practice Address - Phone:270-617-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201160315222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist