Healthcare Provider Details

I. General information

NPI: 1467549857
Provider Name (Legal Business Name): LICKING REHABILITATION SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 HEBRON RD
HEATH OH
43056-1040
US

IV. Provider business mailing address

1220 HEBRON RD
HEATH OH
43056-1040
US

V. Phone/Fax

Practice location:
  • Phone: 740-345-2837
  • Fax: 740-763-0475
Mailing address:
  • Phone: 740-345-2837
  • Fax: 740-763-0475

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

VIII. Authorized Official

Name: JEFF C KONKLER
Title or Position: VICE PRESIDENT
Credential:
Phone: 740-760-0408