Healthcare Provider Details

I. General information

NPI: 1003215617
Provider Name (Legal Business Name): LKPRESS-OTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1216 N BRAND BLVD APT 6
GLENDALE CA
91202-1947
US

IV. Provider business mailing address

1216 N BRAND BLVD APT 6
GLENDALE CA
91202-1947
US

V. Phone/Fax

Practice location:
  • Phone: 661-714-1455
  • Fax:
Mailing address:
  • Phone: 661-714-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10496
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number10496
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY L KELLER
Title or Position: OCCUPATIONAL THERAPIST
Credential: MA, MCM, OTR/L
Phone: 661-714-1455