Provider Demographics
NPI:1730776501
Name:LEMIEUX, PATRICK HENDERSON
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:HENDERSON
Last Name:LEMIEUX
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 WOODGLEN CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-5098
Mailing Address - Country:US
Mailing Address - Phone:859-285-8653
Mailing Address - Fax:
Practice Address - Street 1:7369 HUNTER HILL RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-7954
Practice Address - Country:US
Practice Address - Phone:252-443-0867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA308958225X00000X
IA093013225X00000X
KY242018225X00000X
NVOT-2161225X00000X
AZOTH-007672225X00000X
OR401368225X00000X
NC12512225X00000X
NE2428225X00000X
AK163801225X00000X
MA13737225X00000X
401368225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA13737OtherSTATE LICENSE
AK163801OtherSTATE LICENSE
OR401368OtherSTATE LICENSE
IA093013OtherSTATE LICENSE
NVOT-2161OtherSTATE LICENSE
NE2428OtherSTATE LICENSE
KY242018OtherSTATE LICENSE
401368OtherNATIONAL BOARD OF CERTIFICATION FOR OCCUPATIONAL THERAPY
NC12512OtherSTATE LICENSE
LA308958OtherSTATE LICENSE
AZOTH-007672OtherSTATE LICENSE