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General NPI Number Information
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NPI Number | 1053062000
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Entity Type | Organization
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Legal Business Name | CHAMPION PEDIATRIC THERAPY OF GEORGIA
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Dates
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Enumeration Date | 01/11/2022
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Last Update Date | 01/11/2022
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Provider Practice Location Address
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Address Line | 1481 PLANTATION DR
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City | SANDERSVILLE
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State | GA
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Zip | 31082-7412
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Country | US
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Telephone | 678-617-8833
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Fax |
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Provider Business Mailing Address
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Address Line | 1481 PLANTATION DR
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City | SANDERSVILLE
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State | GA
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Zip | 31082-7412
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/OCCUPATIONAL THERAPIST
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Name | JESSICA BRIDGES
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Credential | OTR/L
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Telephone | 678-617-8833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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