Basic Information
| Provider Information | |||||||||
| NPI: | 1003152745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARPENTER | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | GAY | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1444 PONDSVILLE KEPLER RD | ||||||||
| Address2: | |||||||||
| City: | SMITHS GROVE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421716221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707999703 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1381 CAMPBELL LN | ||||||||
| Address2: | |||||||||
| City: | BOWLING GREEN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 421041049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708430587 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2012 | ||||||||
| LastUpdateDate: | 12/28/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | A3293 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.