Provider Demographics
NPI:1275085961
Name:LIFE LONG OCCUPATIONAL THERAPY SERVICES, INC
Entity Type:Organization
Organization Name:LIFE LONG OCCUPATIONAL THERAPY SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:606-424-8011
Mailing Address - Street 1:1741 HIGHWAY 399
Mailing Address - Street 2:
Mailing Address - City:BEATTYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41311-7974
Mailing Address - Country:US
Mailing Address - Phone:606-424-8011
Mailing Address - Fax:606-464-9633
Practice Address - Street 1:1741 HIGHWAY 399
Practice Address - Street 2:
Practice Address - City:BEATTYVILLE
Practice Address - State:KY
Practice Address - Zip Code:41311-7974
Practice Address - Country:US
Practice Address - Phone:606-424-8011
Practice Address - Fax:606-464-9633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY134454252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency