Healthcare Provider Details

I. General information

NPI: 1023938255
Provider Name (Legal Business Name): ASPEN RICH OTD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 ACADEMY ST STE 102
CANTON GA
30114-3008
US

IV. Provider business mailing address

PO BOX 1901
ROSWELL GA
30077-1901
US

V. Phone/Fax

Practice location:
  • Phone: 404-444-1521
  • Fax: 404-689-4209
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT009922
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: