Provider Demographics
NPI:1720188808
Name:LETTIERI, MARY BETH M (OT)
Entity Type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:M
Last Name:LETTIERI
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 BARDSTOWN RD
Mailing Address - Street 2:STE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-2665
Mailing Address - Country:US
Mailing Address - Phone:502-452-1863
Mailing Address - Fax:502-452-1863
Practice Address - Street 1:2525 BARDSTOWN RD
Practice Address - Street 2:STE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-2665
Practice Address - Country:US
Practice Address - Phone:502-452-1863
Practice Address - Fax:502-452-1863
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist