Provider Demographics
NPI:1821412420
Name:NUTT, JOSEPH COREY (COTA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:COREY
Last Name:NUTT
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 HELMWOOD CIRCLE
Mailing Address - Street 2:
Mailing Address - City:MT. WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047
Mailing Address - Country:US
Mailing Address - Phone:502-220-5318
Mailing Address - Fax:
Practice Address - Street 1:303 N HURSTBOURNE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5185
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32002590A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant