NPIMap

Organization Active NPI

Launch Therapy Clinic

  • Pediatric Occupational Therapist
  • Russellville, KY
National Provider Identifier
1063157899
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
Legal business name
LAUNCH THERAPY CLINIC
Practice address
314 Highland Lick Rd
Russellville, KY 42276-9275
Phone
(270) 893-5600
NPI assigned
May 5, 2022
Last updated
May 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Courtney Patrick, OTD, OTR/L
Title
Owner
Phone
(270) 893-5600

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Physical Therapist 2251P0200X
Pediatric Occupational Therapist 225XP0200X Primary
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

314 Highland Lick Rd
Russellville, KY 42276-9275

Mailing address

610 Green Valley Dr
Russellville, KY 42276-8808
Phone (270) 893-5600

Other identifiers 1

IdentifierTypeStateIssuer
7100872860MedicaidKY

National Provider Directory

National Provider Directory

Locations

314 Highland Lick Rd
Russellville, KY 42276
Phone (270) 238-3782

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1063157899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 GREEN VALLEY DR",
            "city": "RUSSELLVILLE",
            "state": "KY",
            "postal_code": "422768808",
            "telephone_number": "270-893-5600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "314 HIGHLAND LICK RD",
            "city": "RUSSELLVILLE",
            "state": "KY",
            "postal_code": "422769275",
            "telephone_number": "270-893-5600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAUNCH THERAPY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-05",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "PATRICK",
        "authorized_official_first_name": "COURTNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-893-5600",
        "authorized_official_credential": "OTD, OTR/L"
    },
    "taxonomies": [
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100872860",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Russellville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.