Provider Demographics
NPI:1457456501
Name:GABBARD, ROENA FAYE (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ROENA
Middle Name:FAYE
Last Name:GABBARD
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 1:2000 JACKS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9406
Mailing Address - Country:US
Mailing Address - Phone:859-623-4240
Mailing Address - Fax:859-623-4288
Practice Address - Street 1:2000 JACKS CREEK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9406
Practice Address - Country:US
Practice Address - Phone:859-623-4240
Practice Address - Fax:859-623-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKYR0715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYGO-200Medicaid
KY1485OtherFIRST STEPS PROVIDER