Provider Demographics
NPI:1124160999
Name:LIFE SKILLS ENHANCEMENT OCCUPATIONAL THERAPY SERVICES, PC
Entity type:Organization
Organization Name:LIFE SKILLS ENHANCEMENT OCCUPATIONAL THERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:513-258-9586
Mailing Address - Street 1:PO BOX 141049
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45250-1049
Mailing Address - Country:US
Mailing Address - Phone:513-258-9586
Mailing Address - Fax:
Practice Address - Street 1:225A POND WAY
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1645
Practice Address - Country:US
Practice Address - Phone:513-258-9586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013794-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty