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: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 OAKFIELD DR SE
ROME GA
30161-5991
US

IV. Provider business mailing address

26 OAKFIELD DR SE
ROME GA
30161-5991
US

V. Phone/Fax

Practice location:
  • Phone: 706-936-3595
  • Fax:
Mailing address:
  • Phone: 706-936-3595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: EMILY MARIE MCLEMORE
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 706-936-3595