Provider Demographics
NPI:1578531273
Name:MALONE, GRETCHEN KAY (COF)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:KAY
Last Name:MALONE
Suffix:
Gender:F
Credentials:COF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2342
Mailing Address - Country:US
Mailing Address - Phone:502-899-9177
Mailing Address - Fax:502-899-9178
Practice Address - Street 1:4850 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2342
Practice Address - Country:US
Practice Address - Phone:502-899-9177
Practice Address - Fax:502-899-9178
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYCFO00523225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90006156Medicaid
KY4593340001Medicare NSC