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General NPI Number Information
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NPI Number | 1215638259
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Entity Type | Organization
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Legal Business Name | BALANCED BODY AND MIND OT, LLC
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Dates
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Enumeration Date | 03/16/2023
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 1101 JUNIPER ST NE APT 709
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City | ATLANTA
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State | GA
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Zip | 30309-7659
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Country | US
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Telephone | 470-645-1477
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 JUNIPER ST NE APT 709
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City | ATLANTA
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State | GA
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Zip | 30309-7659
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Country | US
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Telephone | 470-645-1477
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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 | ANDREA ARLENE TRENTHAM
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Credential | MS, OTR/L
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Telephone | 470-645-1477
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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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