Healthcare Provider Details

I. General information

NPI: 1700285178
Provider Name (Legal Business Name): DIVERSE THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6740 JAMES B RIVERS DR
STONE MOUNTAIN GA
30083-2235
US

IV. Provider business mailing address

6740 JAMES B RIVERS DR
STONE MOUNTAIN GA
30083-2235
US

V. Phone/Fax

Practice location:
  • Phone: 678-250-3250
  • Fax: 470-375-8754
Mailing address:
  • Phone: 678-250-3250
  • Fax: 470-375-8754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHELLE A TOMLINSON
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTD, OTR/L
Phone: 678-250-3250