Healthcare Provider Details

I. General information

NPI: 1316096555
Provider Name (Legal Business Name): REHAB POTENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 10/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W MAIN ST
THOMASTON GA
30286-3502
US

IV. Provider business mailing address

317 W MAIN ST
THOMASTON GA
30286-3502
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-1717
  • Fax: 706-647-3737
Mailing address:
  • Phone: 706-647-1717
  • Fax: 706-647-3737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number815
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number815
License Number StateGA

VIII. Authorized Official

Name: MRS. ROSANNA HINMAN HAND
Title or Position: OPERATING MANAGER
Credential: O.T., C.H.T.
Phone: 706-647-1717