Healthcare Provider Details

I. General information

NPI: 1093147662
Provider Name (Legal Business Name): SCHOLAR REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2013
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 FRANCES MEEKS WAY STE 9
RICHMOND HILL GA
31324-3984
US

IV. Provider business mailing address

128 FRANCES MEEKS WAY STE 9
RICHMOND HILL GA
31324-3984
US

V. Phone/Fax

Practice location:
  • Phone: 912-507-3919
  • Fax:
Mailing address:
  • Phone: 912-507-3919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET001924
License Number StateGA

VIII. Authorized Official

Name: MRS. LAUREN S SCHOLAR
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 912-727-2321