NPIMap

Organization Active NPI

Marshall Pediatric Therapy, LLC

  • Pediatric Occupational Therapist
  • Nicholasville, KY
National Provider Identifier
1104198472
Registry record updated Feb 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
R3083 Issued in KY
Legal business name
MARSHALL PEDIATRIC THERAPY, LLC
Practice address
109 Wind Haven Dr Ste 100
Nicholasville, KY 40356-8010
Phone
(859) 224-2273
Fax
(859) 224-4675
NPI assigned
Feb 2, 2012
Last updated
Feb 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2025

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

Authorized official

Name
Pam Marshall, OT
Title
Occupational Therapist / Owner
Phone
(859) 224-2273

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X 1196 KY
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 5326 KY
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Physical Rehabilitation Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0019X
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X R3083 KY Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 4077 KY
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

109 Wind Haven Dr Ste 100
Nicholasville, KY 40356-8010

Mailing address

109 Wind Haven Dr Ste 100
Nicholasville, KY 40356-8010
Phone (859) 224-2273

Other practice location 1

3499 Blazer Pkwy Ste 170
Lexington, KY 40509-2823
Phone (859) 224-2273

Other practice location 2

1013 Center Dr
Richmond, KY 40475-3841
Phone (859) 224-2273

Other practice location 3

117 E Jefferson St
Georgetown, KY 40324-1764
Phone (859) 224-2273

Other practice location 4

799 E Brannon Rd
Nicholasville, KY 40356-6038
Phone (859) 224-2273

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120515000163 KY Part B Supplier - Clinic/Group Practice 6406019215 Receives reassigned benefits from 1 practitioner
Practice locations: Nicholasville, KY

National Provider Directory

National Provider Directory
Tax ID family
Marshall Pediatric Therapy LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

117 E Jefferson St
Georgetown, KY 40324
Phone (502) 316-6180

3450 Richmond Rd
Ste 130
Lexington, KY 40509
Phone (859) 899-8763

3499 Blazer Pkwy
Ste 170
Lexington, KY 40509
Phone (859) 327-3033

105 Wind Haven Dr
Ste 1
Nicholasville, KY 40356

109 Wind Haven Dr
Ste 100
Nicholasville, KY 40356
Phone (859) 619-3984

1013 Center Dr
Richmond, KY 40475
Phone (859) 444-5330

Practitioners & affiliated clinicians

Practitioners 137

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.

View all 137

NPI Registry JSON

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740441600000",
    "number": "1104198472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 WIND HAVEN DR STE 100",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403568010",
            "telephone_number": "859-224-2273",
            "fax_number": "859-224-4675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 WIND HAVEN DR STE 100",
            "city": "NICHOLASVILLE",
            "state": "KY",
            "postal_code": "403568010",
            "telephone_number": "859-224-2273",
            "fax_number": "859-224-4675"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3499 Blazer Pkwy Ste 170",
            "address_purpose": "LOCATION",
            "city": "Lexington",
            "state": "KY",
            "postal_code": "405092823",
            "country_code": "US",
            "telephone_number": "859-224-2273",
            "fax_number": "859-224-4675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1013 Center Dr",
            "address_purpose": "LOCATION",
            "city": "Richmond",
            "state": "KY",
            "postal_code": "404753841",
            "country_code": "US",
            "telephone_number": "859-224-2273",
            "fax_number": "859-224-4675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "117 E Jefferson St",
            "address_purpose": "LOCATION",
            "city": "Georgetown",
            "state": "KY",
            "postal_code": "403241764",
            "country_code": "US",
            "telephone_number": "859-224-2273",
            "fax_number": "859-224-4675",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "799 E Brannon Rd",
            "address_purpose": "LOCATION",
            "city": "Nicholasville",
            "state": "KY",
            "postal_code": "403566038",
            "country_code": "US",
            "telephone_number": "859-224-2273",
            "fax_number": "859-224-4675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MARSHALL PEDIATRIC THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-02",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "PAM",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST / OWNER",
        "authorized_official_telephone_number": "859-224-2273",
        "authorized_official_credential": "OT"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "KY",
            "license": "1196",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "5326",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "KY",
            "license": "R3083",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "KY",
            "license": "4077",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nicholasville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.