Provider Demographics
NPI:1841642675
Name:TRACI PURVIS DBA THERAPY BUILDERS
Entity type:Organization
Organization Name:TRACI PURVIS DBA THERAPY BUILDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PURVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:502-302-9024
Mailing Address - Street 1:4211 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1846
Mailing Address - Country:US
Mailing Address - Phone:502-302-9024
Mailing Address - Fax:502-470-7318
Practice Address - Street 1:4211 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1846
Practice Address - Country:US
Practice Address - Phone:502-302-9024
Practice Address - Fax:502-470-7318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2744252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1362OtherFIRST STEPS CABINET FOR HEALTH AND FAMILY SERVICES PROVIDER NUMBER
KYKY-R2744OtherKENTUCKY BOARD OF LICENSURE FOR OCCUPATIONAL THERAPY
KY12084937OtherCAQH
KY1134324114Medicaid