Provider Demographics
NPI:1790057289
Name:PHILLIPS, EMILY ANN (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials: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:PO BOX 185
Mailing Address - Street 2:
Mailing Address - City:STRUNK
Mailing Address - State:KY
Mailing Address - Zip Code:42649-0185
Mailing Address - Country:US
Mailing Address - Phone:606-354-4867
Mailing Address - Fax:
Practice Address - Street 1:150 RUTHFORD RD
Practice Address - Street 2:
Practice Address - City:STRUNK
Practice Address - State:KY
Practice Address - Zip Code:42649
Practice Address - Country:US
Practice Address - Phone:606-354-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2191225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGO126Medicaid