Provider Demographics
NPI:1720486012
Name:DOVETAIL THERAPY, PLLC
Entity Type:Organization
Organization Name:DOVETAIL THERAPY, PLLC
Other - Org Name:DOVETAIL PEDIATRIC THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:270-351-2224
Mailing Address - Street 1:PO BOX 558
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40159-0558
Mailing Address - Country:US
Mailing Address - Phone:270-351-2224
Mailing Address - Fax:502-849-1279
Practice Address - Street 1:645 KNOX BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1514
Practice Address - Country:US
Practice Address - Phone:270-351-2224
Practice Address - Fax:502-849-1279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYBOTOCT00210728225XP0200X, 252Y00000X
KYBOTOCT261QR0400X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty