Provider Demographics
NPI:1689280745
Name:MEDLEY, JOSIE LEE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOSIE
Middle Name:LEE
Last Name:MEDLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:
Other - Last Name:NEVITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:50 GENE CASH RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-4908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 GENE CASH RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4908
Practice Address - Country:US
Practice Address - Phone:270-763-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264094225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist