Provider Demographics
NPI:1033265863
Name:LAKELAND THERAPY PROVIDERS, INC
Entity Type:Organization
Organization Name:LAKELAND THERAPY PROVIDERS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-413-0802
Mailing Address - Street 1:1335 ARIANA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-1879
Mailing Address - Country:US
Mailing Address - Phone:863-413-0802
Mailing Address - Fax:863-413-0812
Practice Address - Street 1:1335 ARIANA ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-1879
Practice Address - Country:US
Practice Address - Phone:863-413-0802
Practice Address - Fax:863-413-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty