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General NPI Number Information
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NPI Number | 1386874758
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Entity Type | Organization
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Legal Business Name | CUSTOM CARE REHAB, INC.
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 501 DARBY CREEK RD SUITE 42
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City | LEXINGTON
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State | KY
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Zip | 40509-1604
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Country | US
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Telephone | 859-288-0038
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Fax | 859-264-0560
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Provider Business Mailing Address
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Address Line | 501 DARBY CREEK RD SUITE 42
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City | LEXINGTON
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State | KY
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Zip | 40509-1604
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Country | US
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Telephone | 859-288-0038
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Fax | 859-264-0560
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LAYNE CHRISTIE SANTOS
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Credential | OTR/L
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Telephone | 859-288-0038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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