Healthcare Provider Details

I. General information

NPI: 1619583382
Provider Name (Legal Business Name): CAPABILITIES THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 09/18/2020
Certification Date: 09/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 SHILOH RD NW STE 303
KENNESAW GA
30144-7197
US

IV. Provider business mailing address

925 LAUREL CREST DR
WOODSTOCK GA
30189-6897
US

V. Phone/Fax

Practice location:
  • Phone: 678-779-0842
  • Fax: 678-623-5750
Mailing address:
  • Phone: 678-779-0842
  • Fax: 678-623-5750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE LYNN WATTS
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential: OTR/L
Phone: 678-779-0842