Provider Demographics
NPI:1831745918
Name:ANNAPOLIS CHILDREN'S THERAPY CENTER LLC
Entity type:Organization
Organization Name:ANNAPOLIS CHILDREN'S THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:HILLMANN PRENTICE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:410-573-1064
Mailing Address - Street 1:1911 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4118
Mailing Address - Country:US
Mailing Address - Phone:410-573-1064
Mailing Address - Fax:410-573-1065
Practice Address - Street 1:1350 BLAIR DR # H1
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1333
Practice Address - Country:US
Practice Address - Phone:410-573-1064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty