MEDICARE: ATLANTA KIDS THERAPY, 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	225X00000X	Occupational Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952970113
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA KIDS THERAPY, LLC

Provider Business Mailing Address
First Line	:	1843 SHENLEY PARK LN
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30097-4922
Country	:	US
Telephone Number	:	440-665-7965
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 VILLAGE GREEN CIR SE STE 201A
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-3476
Country	:	US
Telephone Number	:	440-665-7965
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NIRALI SHAH
Credential	:	OTR/L
Telephone Number	:	440-665-7965

Provider Enumeration Date	:	06/22/2021
Last Update Date	:	03/25/2026

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