Healthcare Provider Details

I. General information

NPI: 1346430329
Provider Name (Legal Business Name): AUGUSTA THERAPY SERVICES FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 06/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 STANTON DR
NORTH AUGUSTA SC
29841-3264
US

IV. Provider business mailing address

PO BOX 12094
AUGUSTA GA
30914-2094
US

V. Phone/Fax

Practice location:
  • Phone: 706-294-3773
  • Fax: 803-202-0334
Mailing address:
  • Phone: 706-589-3773
  • Fax: 803-202-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: EMILY D. ANDERSON I
Title or Position: PRESIDENT/DIRECTOR
Credential: MHE,OTR/L
Phone: 706-294-3773