Healthcare Provider Details

I. General information

NPI: 1295678704
Provider Name (Legal Business Name): MUSTARD SEED THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PROFESSIONAL CT SW STE B
ROME GA
30165-2806
US

IV. Provider business mailing address

14 PROFESSIONAL CT SW STE B
ROME GA
30165-2806
US

V. Phone/Fax

Practice location:
  • Phone: 706-237-9798
  • Fax: 706-245-4424
Mailing address:
  • Phone: 706-237-9798
  • Fax: 706-245-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMILY MARIE MCLEMORE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 706-237-9798