Healthcare Provider Details

I. General information

NPI: 1578689329
Provider Name (Legal Business Name): ANNAPOLIS CHILDREN'S THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 LINCOLN DRIVE
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

1911 LINCOLN DRIVE
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 410-573-1064
  • Fax: 410-573-1065
Mailing address:
  • Phone: 410-573-1064
  • Fax: 410-573-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: RENEE MICHELLE HILLMANN PRENTICE
Title or Position: OWNER
Credential:
Phone: 410-573-1064