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General NPI Number Information
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NPI Number | 1639729460
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Entity Type | Organization
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Legal Business Name | LAKE CUMBERLAND THERAPY CENTER, INC.
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Dates
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Enumeration Date | 09/13/2019
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Last Update Date | 11/04/2019
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Provider Practice Location Address
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Address Line | 153 HIGH STREET
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City | MONTICELLO
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State | KY
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Zip | 42633
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Country | US
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Telephone | 606-219-3155
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Fax | 606-348-7241
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Provider Business Mailing Address
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Address Line | 153 HIGH STREET
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City | MONTICELLO
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State | KY
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Zip | 42633
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Country | US
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Telephone | 606-219-3155
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Fax | 606-348-7241
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Authorized Official
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Title or Position | PRESIDENT/DEVELOPMENTAL THERAPIST
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Name | JENNFIER ANNETTE BAKER
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Credential |
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Telephone | 606-219-3155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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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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