Provider Demographics
NPI:1205276292
Name:ROSS, ETHEL (DEVELOPMENTAL INTERV)
Entity type:Individual
Prefix:MRS
First Name:ETHEL
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:DEVELOPMENTAL INTERV
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 726
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311
Mailing Address - Country:US
Mailing Address - Phone:606-560-0081
Mailing Address - Fax:
Practice Address - Street 1:315 ROLLING ACRES RD
Practice Address - Street 2:
Practice Address - City:BEAYTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40311
Practice Address - Country:US
Practice Address - Phone:606-560-0081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY201149812222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist