Basic Information
Provider Information
NPI: 1356336465
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NEVILLE
FirstName: ROBERT
MiddleName: BRIAN
NamePrefix: MR.
NameSuffix:  
Credential: OTR/L, CHT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 151 N EAGLE CREEK DR
Address2: SUITE 400
City: LEXINGTON
State: KY
PostalCode: 405091889
CountryCode: US
TelephoneNumber: 8592648866
FaxNumber: 8592641167
Practice Location
Address1: 151 N EAGLE CREEK DR
Address2: SUITE 400
City: LEXINGTON
State: KY
PostalCode: 405091889
CountryCode: US
TelephoneNumber: 8592648866
FaxNumber: 8592641167
Other Information
ProviderEnumerationDate: 09/14/2005
LastUpdateDate: 12/20/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225XH1200XR2216KYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand

No ID Information.


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