Provider Demographics
NPI:1629232673
Name:SERGENT, MICHAEL A (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SERGENT
Suffix:
Gender:M
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:PO BOX 79
Mailing Address - Street 2:
Mailing Address - City:PARTRIDGE
Mailing Address - State:KY
Mailing Address - Zip Code:40862-0079
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19101 US 119
Practice Address - Street 2:BRITTHAVEN OF TRI-CITIES
Practice Address - City:CUMBERLAND
Practice Address - State:KY
Practice Address - Zip Code:40823-0079
Practice Address - Country:US
Practice Address - Phone:606-589-4734
Practice Address - Fax:606-589-4734
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR-1606225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist