Provider Demographics
NPI:1922388776
Name:WHEATLEY, JOLENE (OTR/L)
Entity Type:Individual
Prefix:
First Name:JOLENE
Middle Name:
Last Name:WHEATLEY
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 1:123 CROSS CREEK COURT
Mailing Address - Street 2:
Mailing Address - City:COX'S CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40013
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:123 CROSS CREEK CT
Practice Address - Street 2:
Practice Address - City:COXS CREEK
Practice Address - State:KY
Practice Address - Zip Code:40013-6618
Practice Address - Country:US
Practice Address - Phone:502-836-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2210225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist