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General NPI Number Information
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NPI Number | 1306155742
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Entity Type | Organization
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Legal Business Name | PRACTICAL REHABILITATION SERVICES, LLC
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Dates
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Enumeration Date | 10/04/2010
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 124 E WASHINGTON ST STE C
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City | DEWITT
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State | MI
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Zip | 48820-8826
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Country | US
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Telephone | 855-777-9297
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Fax | 517-394-3604
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Provider Business Mailing Address
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Address Line | PO BOX 794
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City | OKEMOS
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State | MI
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Zip | 48805-0794
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Country | US
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Telephone | 517-282-7779
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Fax | 517-394-3604
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Authorized Official
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Title or Position | OWNER
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Name | MS. AMANDA MARIE LAKE
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Credential | MA-CCC-SLP
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Telephone | 517-282-7779
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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