Basic Information
| Provider Information | |||||||||
| NPI: | 1750322079 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JONES | ||||||||
| FirstName: | GWENDOLYN | ||||||||
| MiddleName: | KAYE | ||||||||
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| Credential: | OTR/L - LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 N EAGLE CREEK DR | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405091889 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592648868 | ||||||||
| FaxNumber: | 8592648878 | ||||||||
| Practice Location | |||||||||
| Address1: | 1010 MONARCH ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405131497 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592961696 | ||||||||
| FaxNumber: | 8592961676 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 12/02/2015 | ||||||||
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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 | 225X00000X | R3461 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 11494494 | 01 | KY | CAQH | OTHER |