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General NPI Number Information
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NPI Number | 1386952422
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Entity Type | Organization
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Legal Business Name | LEARNING LIFE SKILLS LLC
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Dates
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Enumeration Date | 09/23/2010
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Last Update Date | 09/23/2010
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Provider Practice Location Address
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Address Line | 1710 KENNERSLY CLOSE
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City | TUCKER
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State | GA
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Zip | 30084-6728
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Country | US
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Telephone | 770-491-8551
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 KENNERSLY CLOSE
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City | TUCKER
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State | GA
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Zip | 30084-6728
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Country | US
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Telephone | 770-491-8551
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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 | MS. MARY JOYCE JAMES-RICKS
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Credential | MS, OTR/L
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Telephone | 404-786-5989
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | OT003667
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License Number State | GA
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