Healthcare Provider Details

I. General information

NPI: 1255511051
Provider Name (Legal Business Name): INTEGRATED THERAPY SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 MCDONALD CT
LEESBURG GA
31763-6208
US

IV. Provider business mailing address

181 MCDONALD CT
LEESBURG GA
31763-6208
US

V. Phone/Fax

Practice location:
  • Phone: 229-854-7216
  • Fax:
Mailing address:
  • Phone: 229-854-7216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4320
License Number StateGA

VIII. Authorized Official

Name: AMY LUPARDUS
Title or Position: OWNER/ OCCUPATIONAL THERAPIST
Credential: M.S.,OTR/L
Phone: 229-854-7216