Provider Demographics
NPI:1023246675
Name:KENTUCKY ORTHOTIC PROVIDERS, LLC
Entity type:Organization
Organization Name:KENTUCKY ORTHOTIC PROVIDERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:REIBLING
Authorized Official - Suffix:
Authorized Official - Credentials:BSME, MBA
Authorized Official - Phone:502-649-5468
Mailing Address - Street 1:PO BOX 99042
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40269-0042
Mailing Address - Country:US
Mailing Address - Phone:502-649-5468
Mailing Address - Fax:
Practice Address - Street 1:800 STONE CREEK PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-5366
Practice Address - Country:US
Practice Address - Phone:502-649-5468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0728233332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEMPLOYER IDENTIFICATION NUMBER