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General NPI Number Information
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NPI Number | 1114438975
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Entity Type | Organization
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Legal Business Name | AEGIS THERAPIES GROUP PRACTICE LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 300 CHARTER BLVD
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City | MACON
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State | GA
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Zip | 31210-4875
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Country | US
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Telephone | 800-444-6845
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 FIANNA WAY
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City | FORT SMITH
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State | AR
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Zip | 72919-9008
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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 | OCCUPATIONAL THERAPIST
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Name | LAUREN LEBLANC HUFFMAN
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Credential | MOT
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Telephone | 985-869-3214
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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 | OT006397
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License Number State | GA
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