Provider Demographics
NPI:1003215617
Name:LKPRESS-OTR
Entity Type:Organization
Organization Name:LKPRESS-OTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, MCM, OTR/L
Authorized Official - Phone:661-714-1455
Mailing Address - Street 1:1216 N BRAND BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-1947
Mailing Address - Country:US
Mailing Address - Phone:661-714-1455
Mailing Address - Fax:
Practice Address - Street 1:1216 N BRAND BLVD APT 6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91202-1947
Practice Address - Country:US
Practice Address - Phone:661-714-1455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10496174400000X, 252Y00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider Agency
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty