Healthcare Provider Details

I. General information

NPI: 1396369633
Provider Name (Legal Business Name): JOURNEY THERAPY CONNECTION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 YORK VIEW DR
AUBURN GA
30011-4631
US

IV. Provider business mailing address

673 YORK VIEW DR
AUBURN GA
30011-4631
US

V. Phone/Fax

Practice location:
  • Phone: 770-294-6629
  • Fax:
Mailing address:
  • Phone: 770-294-6629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XE0001X
TaxonomyEnvironmental Modification Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225XH1300X
TaxonomyHuman Factors Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ROSE JARDA NEPTUNE
Title or Position: CEO
Credential:
Phone: 770-294-6629