Healthcare Provider Details

I. General information

NPI: 1700127446
Provider Name (Legal Business Name): FOCUS THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 RILEY ESTATES DR
LITHIA SPRINGS GA
30122-2194
US

IV. Provider business mailing address

810 RILEY ESTATES DR
LITHIA SPRINGS GA
30122-2194
US

V. Phone/Fax

Practice location:
  • Phone: 770-819-7690
  • Fax: 770-819-7907
Mailing address:
  • Phone: 770-819-7690
  • Fax: 770-819-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberOT002648
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier225X00000X
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name: MS. JACQUELINE WYNTER
Title or Position: OCCUPATIONAL THERAPIST
Credential: MS, OTR/L
Phone: 770-819-7690