Healthcare Provider Details

I. General information

NPI: 1679515985
Provider Name (Legal Business Name): CSRA THERAPY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 05/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2485 GA HIGHWAY 88
HEPHZIBAH GA
30815-4691
US

IV. Provider business mailing address

PO BOX 537
HEPHZIBAH GA
30815-0537
US

V. Phone/Fax

Practice location:
  • Phone: 706-592-5565
  • Fax: 706-592-5565
Mailing address:
  • Phone: 706-592-5565
  • Fax: 706-592-5565

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. RACHELLE CLARK
Title or Position: OWNER
Credential: OT
Phone: 706-592-5565