Healthcare Provider Details

I. General information

NPI: 1518884246
Provider Name (Legal Business Name): SAWNEE MOUNTAIN PEDIATRIC THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 SAWNEE VILLAGE BLVD UNIT 3410
CUMMING GA
30040-3196
US

IV. Provider business mailing address

525 SAWNEE VILLAGE BLVD UNIT 3410
CUMMING GA
30040-3196
US

V. Phone/Fax

Practice location:
  • Phone: 770-530-1343
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MEGAN MOORE
Title or Position: OWNER
Credential: OTR/L
Phone: 770-530-1343