Provider Demographics
NPI:1396434841
Name:LYMPHEDEMA THERAPY OF SOUTHERN KY LLC
Entity type:Organization
Organization Name:LYMPHEDEMA THERAPY OF SOUTHERN KY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LYMPHEDEMA THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, CLT, CWT
Authorized Official - Phone:270-847-8031
Mailing Address - Street 1:875 EARL RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-7116
Mailing Address - Country:US
Mailing Address - Phone:270-847-8031
Mailing Address - Fax:
Practice Address - Street 1:875 EARL RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-7116
Practice Address - Country:US
Practice Address - Phone:270-847-8031
Practice Address - Fax:270-743-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-02
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty