| NPI | 1639526940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACEY LYNNE FOWL Developmental Interventionist 270-300-2044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305S00000X Point of Service (Licence: KY EDSP 71846) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2016-05-17 |