Provider Demographics
NPI:1932445541
Name:RYLEN, JENNIFER LANE (COTA/L)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LANE
Last Name:RYLEN
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 18 MILE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:KY
Mailing Address - Zip Code:40077-9701
Mailing Address - Country:US
Mailing Address - Phone:502-222-0098
Mailing Address - Fax:
Practice Address - Street 1:905 HIGHWAY 127 N
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-9302
Practice Address - Country:US
Practice Address - Phone:502-484-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2012-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA3659224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant