Provider Demographics
NPI:1598267031
Name:BUTH, LORA ROSE (OTR)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:ROSE
Last Name:BUTH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:LORA
Other - Middle Name:JO
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:4717 FAIRWAY POINTE CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3431
Mailing Address - Country:US
Mailing Address - Phone:606-571-2857
Mailing Address - Fax:
Practice Address - Street 1:4717 FAIRWAY POINTE CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3431
Practice Address - Country:US
Practice Address - Phone:606-571-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY174806225X00000X
IN31006550A225X00000X
KY175806252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist