Provider Demographics
NPI:1689083503
Name:LKM THERAPY CENTER
Entity Type:Organization
Organization Name:LKM THERAPY CENTER
Other - Org Name:IMPRESSIONS PEDIATRIC THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:HAWKINS
Authorized Official - Last Name:TITUS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:301-233-2268
Mailing Address - Street 1:1702 TREE DUCK CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-7114
Mailing Address - Country:US
Mailing Address - Phone:301-233-2268
Mailing Address - Fax:
Practice Address - Street 1:1702 TREE DUCK CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-7114
Practice Address - Country:US
Practice Address - Phone:301-233-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty