MEDICARE: PURPOSEFUL AGING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1578417218
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPOSEFUL AGING LLC

Provider Business Mailing Address
First Line	:	2048 SANDERLINGS DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-5816
Country	:	US
Telephone Number	:	404-277-1474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2048 SANDERLINGS DR NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-5816
Country	:	US
Telephone Number	:	404-277-1474
Fax Number	:

Authorized Official
Title or Position	:	OWNER, OCCUPATIONAL THERAPIST
Name	:	KORI NUZUM
Credential	:	OTR/L
Telephone Number	:	404-277-1474

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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Directions to “PURPOSEFUL AGING LLC ” Practice Location

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