Organization
THERA KIDS, LLC
Active
Organization
THERA KIDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL MARCUM OTR/L (PRESIDENT/OCCUPATIONAL THERAPIST)
(606) 599-2079
Entity
Organization
Contact information
Practice address
77 MIZE BRANCH RD, MANCHESTER, KY 40962-6632
(606) 599-2079
(606) 599-5437
Mailing address
77 MIZE BRANCH RD, MANCHESTER, KY 40962-6632
(606) 599-2079
(606) 599-5437
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
004379
KY
225X00000X
Occupational Therapist
Primary
R1597
KY
235Z00000X
Speech-Language Pathologist
1845
KY
Other
Enumeration date
10/12/2015
Last updated
10/12/2015
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