Provider Demographics
NPI:1639729460
Name:LAKE CUMBERLAND THERAPY CENTER, INC.
Entity Type:Organization
Organization Name:LAKE CUMBERLAND THERAPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNFIER
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-219-3155
Mailing Address - Street 1:153 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633
Mailing Address - Country:US
Mailing Address - Phone:606-219-3155
Mailing Address - Fax:606-348-7241
Practice Address - Street 1:153 HIGH STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633
Practice Address - Country:US
Practice Address - Phone:606-219-3155
Practice Address - Fax:606-348-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-13
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty