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General NPI Number Information
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NPI Number | 1750635967
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Entity Type | Organization
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Legal Business Name | COMPLETE IN-HOME THERAPY LLC
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Dates
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Enumeration Date | 11/09/2012
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 430 MANSFIELD RD
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City | ASHFORD
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State | CT
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Zip | 06278-1416
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Country | US
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Telephone | 860-573-4923
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Fax |
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Provider Business Mailing Address
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Address Line | 430 MANSFIELD RD
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City | ASHFORD
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State | CT
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Zip | 06278-1416
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Country | US
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Telephone | 860-573-4923
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MR. KEITH ALEXANDER LYONS
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Credential | MS, RPT
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Telephone | 860-573-4923
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | LLC 1084683
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License Number State | CT
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