MEDICARE: SPECIAL NEEDS PEDIATRIC THERAPY SERVICES

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	2251P0200X	Pediatric Physical Therapist	001565	GA
2	225XP0200X	Pediatric Occupational Therapist	003562	GA
3	225XP0200X	Pediatric Occupational Therapist	001582	GA
4	225XP0200X	Pediatric Occupational Therapist	002798	GA
5	225XP0200X	Pediatric Occupational Therapist	004017	GA
6	2251P0200X	Pediatric Physical Therapist	004301	GA

General Provider Information

NPI Number	:	1770754475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPECIAL NEEDS PEDIATRIC THERAPY SERVICES

Provider Business Mailing Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE 455
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	678-714-6708
Fax Number	:	770-456-5224

Provider Business Practice Location Address
First Line	:	4411 SUWANEE DAM RD
Second Line	:	SUITE 455
City	:	SUWANEE
State	:	GA
Zip	:	30024-8701
Country	:	US
Telephone Number	:	678-714-6708
Fax Number	:	770-456-5224

Authorized Official
Title or Position	:	OWNER
Name	:	DENISE HOELL
Credential	:	PT
Telephone Number	:	678-714-6708

Provider Enumeration Date	:	03/20/2008
Last Update Date	:	03/20/2008

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Directions to “SPECIAL NEEDS PEDIATRIC THERAPY SERVICES ” Practice Location

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