Healthcare Provider Details

I. General information

NPI: 1902730112
Provider Name (Legal Business Name): EMPOWER RECREATIONAL THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1632 TAPPAHANNOCK TRL
MARIETTA GA
30062-2088
US

IV. Provider business mailing address

PO BOX 965501
MARIETTA GA
30066-0009
US

V. Phone/Fax

Practice location:
  • Phone: 717-793-0687
  • Fax: 855-717-1948
Mailing address:
  • Phone: 717-793-0687
  • Fax: 855-717-1948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name: LAURA KELLY
Title or Position: OWNER
Credential: MS, CTRS, FDRT
Phone: 717-793-0673