Provider Demographics
NPI:1174720932
Name:HOOVER-KELLEY, CHERYL H (OTR/L)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:H
Last Name:HOOVER-KELLEY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 PERSIMMON RIDGE DR.
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245
Mailing Address - Country:US
Mailing Address - Phone:502-296-7822
Mailing Address - Fax:
Practice Address - Street 1:11902 OAK BAY PL.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-7410
Practice Address - Country:US
Practice Address - Phone:502-968-9110
Practice Address - Fax:877-212-2525
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R2480225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186592Medicare ID - Type Unspecified