Mara Childers
Individual provider Active NPI Occupational Therapist · Hippo, KY
NPI 1003284480 · NPPES record last updated Sep 2, 2015
Key facts
- NPI
- 1003284480
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- BOTOCT00222178 (KY)
- Practice address
- 4777 Ky Route 850
Hippo, KY 41653-8331 - Phone
- (606) 791-7435
- NPI assigned
- Sep 2, 2015
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BOTOCT00222178 | KY | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bluegrass Family Chiropractic PLLC | Current |
Accepting new patients |
Locations
530 S Lake Dr
Prestonsburg, KY 41653
Phone (606) 886-1416
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | BOTOCT00222178 | KY | Yes |
Addresses
Primary practice location
4777 Ky Route 850
Hippo, KY 41653-8331
Mailing address
4777 Ky Route 850
Hippo, KY 41653-8331
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.