Provider Demographics
NPI:1578689329
Name:ANNAPOLIS CHILDREN'S THERAPY CENTER LLC
Entity type:Organization
Organization Name:ANNAPOLIS CHILDREN'S THERAPY CENTER LLC
Other - Org Name:<UNAVAIL>
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:
Authorized Official - Phone:410-573-1064
Mailing Address - Street 1:1911 LINCOLN DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-573-1064
Mailing Address - Fax:410-573-1065
Practice Address - Street 1:1911 LINCOLN DRIVE
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-573-1064
Practice Address - Fax:410-573-1065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty