Provider Demographics
NPI:1730310152
Name:FAULKNER, BOBBIE NICOLE (BS IN OT)
Entity Type:Individual
Prefix:MRS
First Name:BOBBIE
Middle Name:NICOLE
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:BS IN OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:99 KELSO TRL
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8502
Mailing Address - Country:US
Mailing Address - Phone:859-893-2533
Mailing Address - Fax:606-864-6602
Practice Address - Street 1:99 KELSO TRL
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-8502
Practice Address - Country:US
Practice Address - Phone:859-893-2533
Practice Address - Fax:606-864-6602
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3447225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist