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General NPI Number Information
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NPI Number | 1215024385
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Entity Type | Organization
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Legal Business Name | RISING STARS CHILDREN'S THERAPY, INC.
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Dates
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Enumeration Date | 10/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3595 CANTON RD SUITE A9, #321
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City | MARIETTA
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State | GA
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Zip | 30066-2658
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Country | US
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Telephone | 770-517-6357
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Fax | 770-783-1398
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Provider Business Mailing Address
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Address Line | 3595 CANTON RD SUITE A9, #321
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City | MARIETTA
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State | GA
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Zip | 30066-2658
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Country | US
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Telephone | 770-517-6357
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Fax | 770-783-1398
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | MRS. KRISTI A. ESTES
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Credential | OTR/L
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Telephone | 770-517-6357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT003784
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License Number State | GA
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