Marshall Pediatric Therapy, LLC
Organization Active NPI Pediatric Occupational Therapist · Nicholasville, KY
NPI 1104198472 · NPPES record last updated Feb 25, 2025
Key facts
- NPI
- 1104198472
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Occupational Therapist 225XP0200X
- License
- R3083 (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
- Organization subpart
- No
Authorized official
- Name
- Pam Marshall, OT
- Title
- Occupational Therapist / Owner
- Phone
- (859) 224-2273
Corporate family (same tax ID) 4
Practitioners 100
-
Jenna Atwood, OT
-
Carrie Beth Blankenship, MS CCC-SLP
-
Rachel Booth, SLP
-
Lindsay Cha, MA, CCC-SLP
-
Micaela Cook, OT
-
Tayler Craft, SLP
-
Chelsea Elaine Dalton, MS, OTR/L
-
Travis Faulkner, LPCC
-
Christina J Ferrell, OTR/L
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120515000163 | KY | Part B Supplier - Clinic/Group Practice | 6406019215 |
Receives reassigned benefits from 1 practitioner Practice locations: Nicholasville, KY |
National Provider Directory
- Tax ID family
- Marshall Pediatric Therapy LLC
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
799 E Brannon Rd
Nicholasville, KY 40356
Phone (859) 971-4658
1013 Center Dr
Richmond, KY 40475
Phone (859) 444-5330
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | 1196 | KY | |
| Physical Therapist |
225100000X | 5326 | KY | |
| Occupational Therapist |
225X00000X | |||
| Physical Rehabilitation Occupational Therapist |
225XP0019X | |||
| Pediatric Occupational Therapist |
225XP0200X | R3083 | KY | Yes |
| Speech-Language Pathologist |
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
1013 Center Dr
Richmond, KY 40475-3841
Phone (859) 224-2273
Other practice location 2
117 E Jefferson St
Georgetown, KY 40324-1764
Phone (859) 224-2273
Other practice location 3
3499 Blazer Pkwy Ste 170
Lexington, KY 40509-2823
Phone (859) 224-2273
Other practice location 4
799 E Brannon Rd
Nicholasville, KY 40356-6038
Phone (859) 224-2273
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100328480 | Medicaid | KY | |
| 7100278210 | Medicaid | KY | |
| 7100205670 | Medicaid | KY | |
| 7100299670 | Medicaid | KY | |
| 7100215800 | Medicaid | KY | |
| 7100275720 | Medicaid | KY | |
| 7101016200 | Medicaid | KY |
Other providers in Nicholasville, KY
- M. R. Bishop DMD & Associates, PSC
- Allison Maggard
- Magnolia Dentistry PLLC
- Wayne A. Marlowe
- Allison Marsh
- Pamela Marie Marshall
- Jennifer K Martin
- Clay S Mattson
- Charles Leon Maupin III
- Steven Christopher Mayes
All providers in Nicholasville, KY · Pediatric Occupational Therapist in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 25, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.