Provider Demographics
NPI:1770004897
Name:KYGER, JOHANNA (OTRL)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:KYGER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 SOURWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NANCY
Mailing Address - State:KY
Mailing Address - Zip Code:42544-7681
Mailing Address - Country:US
Mailing Address - Phone:606-485-5074
Mailing Address - Fax:
Practice Address - Street 1:67 JACKS LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-6152
Practice Address - Country:US
Practice Address - Phone:606-425-4371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264542225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist