Healthcare Provider Details

I. General information

NPI: 1982854303
Provider Name (Legal Business Name): THERPY, INTERVENTION, PROGRAMS & SERVICES FOR CHILDREN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2008
Last Update Date: 09/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 SHIELDS RD
DALTON GA
30720-5091
US

IV. Provider business mailing address

711 SHIELDS RD
DALTON GA
30720-5091
US

V. Phone/Fax

Practice location:
  • Phone: 706-278-3839
  • Fax: 706-259-7432
Mailing address:
  • Phone: 706-278-3839
  • Fax: 706-259-7432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. CYNTHIA L MICHAELS
Title or Position: PRESIDENT
Credential: OTR/L
Phone: 706-278-3839