Provider Demographics
NPI:1598986606
Name:BOND, EBONY (MS, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:EBONY
Middle Name:
Last Name:BOND
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:970 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-3250
Mailing Address - Country:US
Mailing Address - Phone:502-650-4120
Mailing Address - Fax:502-780-6700
Practice Address - Street 1:970 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3250
Practice Address - Country:US
Practice Address - Phone:502-650-4120
Practice Address - Fax:502-780-6700
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3450225X00000X
KY132307225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100692960Medicaid