Healthcare Provider Details

I. General information

NPI: 1083193932
Provider Name (Legal Business Name): THERAPY FOR ALL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2018
Last Update Date: 08/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 TEEL MOUNTAIN DR
CLEVELAND GA
30528-0710
US

IV. Provider business mailing address

329 TEEL MOUNTAIN DR
CLEVELAND GA
30528-0710
US

V. Phone/Fax

Practice location:
  • Phone: 706-201-9661
  • Fax:
Mailing address:
  • Phone: 706-201-9661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT003487
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateGA

VIII. Authorized Official

Name: JULIE GOODMAN
Title or Position: OWNER
Credential:
Phone: 706-201-9661