Healthcare Provider Details

I. General information

NPI: 1285873331
Provider Name (Legal Business Name): FREEDOM OCCUPATIONAL THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2009
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 SPRINGDALE CIR SW
ATLANTA GA
30315-6106
US

IV. Provider business mailing address

2164 SPRINGDALE CIR SW
ATLANTA GA
30315-6106
US

V. Phone/Fax

Practice location:
  • Phone: 404-357-9509
  • Fax: 404-761-8632
Mailing address:
  • Phone: 404-357-9509
  • Fax: 404-761-8632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberOT004416
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberOT004416
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberOT004416
License Number StateGA

VIII. Authorized Official

Name: MICHELLE A LEFFALL
Title or Position: OWNEER
Credential: OTR/L
Phone: 404-357-9509