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General NPI Number Information
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NPI Number | 1063011849
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Entity Type | Organization
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Legal Business Name | EDC HOME MODIFICATIONS LLC
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Dates
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Enumeration Date | 10/22/2020
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 2674 FLAIR KNOLL DR NE
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City | ATLANTA
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State | GA
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Zip | 30345-1318
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Country | US
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Telephone | 678-665-3589
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Fax |
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Provider Business Mailing Address
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Address Line | 2674 FLAIR KNOLL DR NE
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City | ATLANTA
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State | GA
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Zip | 30345-1318
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Country | US
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Telephone | 678-665-3589
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Fax |
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Authorized Official
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Title or Position | PROVIDET/OWNER
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Name | ERIN DICHIARA
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Credential | OT
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Telephone | 678-665-3589
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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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