Carlenia Irene Gose, COTA/L

Individual provider Active NPI Occupational Therapy Assistant · Hyden, KY

NPI 1962866319 · NPPES record last updated Apr 12, 2016

Key facts

NPI
1962866319
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
BOTOTA00220358 (KY)
Practice address
130 Kate Ireland Dr
Hyden, KY 41749-9071
Phone
(606) 672-1127
Fax
(606) 672-1966
NPI assigned
Apr 12, 2016
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
BOTOTA00220358KYMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X BOTOTA00220358 KY Yes

Addresses

Primary practice location

130 Kate Ireland Dr
Hyden, KY 41749-9071

Mailing address

299 Gose Holw
Mayking, KY 41837-9033
Phone (606) 672-1127

Other providers in Hyden, KY

All providers in Hyden, KY · Occupational Therapy Assistant in Kentucky

Sources for this page

Verify at the official NPI Registry.