Basic Information
| Provider Information | |||||||||
| NPI: | 1033265863 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LAKELAND THERAPY PROVIDERS, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1335 ARIANA ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634130802 | ||||||||
| FaxNumber: | 8634130812 | ||||||||
| Practice Location | |||||||||
| Address1: | 1335 ARIANA ST | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338031879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8634130802 | ||||||||
| FaxNumber: | 8634130812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COUGHLIN | ||||||||
| AuthorizedOfficialFirstName: | KERRY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OTR | ||||||||
| AuthorizedOfficialTelephone: | 8634130802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.