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General NPI Number Information
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NPI Number | 1134873904
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Entity Type | Organization
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Legal Business Name | KAIA REHAB & WELLNESS LLC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1321 SUGARLOAF RESERVE DR
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City | DULUTH
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State | GA
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Zip | 30097-4054
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Country | US
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Telephone | 770-807-4503
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Fax |
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Provider Business Mailing Address
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Address Line | 5805 STATE BRIDGE RD STE G, #224
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City | JOHNS CREEK
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State | GA
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Zip | 30097
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Country | US
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Telephone | 770-807-4503
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Fax | 470-517-7334
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Authorized Official
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Title or Position | OTR/SOLE PROPRIETOR
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Name | MS. TIMILYN CLARK
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Credential | OTR
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Telephone | 770-807-4503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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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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