Healthcare Provider Details

I. General information

NPI: 1083891907
Provider Name (Legal Business Name): LIFTING SPIRITS THERAPY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRING ST SE STE 101
GAINESVILLE GA
30501-3773
US

IV. Provider business mailing address

PO BOX 1071
GAINESVILLE GA
30503-1071
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-7676
  • Fax: 770-615-0177
Mailing address:
  • Phone: 678-908-7057
  • Fax: 770-536-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT006677
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT009992
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT005167
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT003657
License Number StateGA

VIII. Authorized Official

Name: MISS YURIDIA GARZA
Title or Position: OCCUPATIONAL THERAPIST-OWNER
Credential: MS OTR/L
Phone: 678-908-7057