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General NPI Number Information
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NPI Number | 1306568886
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Entity Type | Organization
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Legal Business Name | LAKE REGION FUNCTIONAL THERAPY LLC
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 2575 ROUTE 6 STE 2
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City | HAWLEY
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State | PA
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Zip | 18428-7066
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Country | US
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Telephone | 570-228-2248
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Fax | 570-227-1914
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Provider Business Mailing Address
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Address Line | 2575 ROUTE 6 STE 2
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City | HAWLEY
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State | PA
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Zip | 18428-7066
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Country | US
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Telephone | 570-228-2248
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Fax | 570-227-1914
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Authorized Official
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Title or Position | OWNER/SPEECH PATHOLOGIST
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Name | KRYSTAL ANGELICA LLOYD
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Credential | M.S. CCC-SLP
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Telephone | 570-228-2248
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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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