Provider Demographics
NPI:1710137724
Name:DEGRAFFENREID, AMY RENEE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:RENEE
Last Name:DEGRAFFENREID
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 1:6515 LANTERN DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40228
Mailing Address - Country:US
Mailing Address - Phone:502-968-5651
Mailing Address - Fax:
Practice Address - Street 1:6515 LANTERN DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40228
Practice Address - Country:US
Practice Address - Phone:502-968-5651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4031225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist