Provider Demographics
NPI:1174941785
Name:ORRICK, TOBIE (COTA)
Entity type:Individual
Prefix:
First Name:TOBIE
Middle Name:
Last Name:ORRICK
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ASHBY LANE
Mailing Address - Street 2:PO BOX 308
Mailing Address - City:SEBREE
Mailing Address - State:KY
Mailing Address - Zip Code:42455
Mailing Address - Country:US
Mailing Address - Phone:270-584-3986
Mailing Address - Fax:
Practice Address - Street 1:303 N. HURSTBOURNE PARKWAY, SUITE 200
Practice Address - Street 2:PARAGON REHABILITATION
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222
Practice Address - Country:US
Practice Address - Phone:502-412-5847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA5507224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant