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General NPI Number Information
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NPI Number | 1508400763
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Entity Type | Organization
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Legal Business Name | RECESS PEDIATRIC THERAPY
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Dates
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Enumeration Date | 10/31/2019
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Last Update Date | 10/31/2019
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Provider Practice Location Address
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Address Line | 5908 COBBLESTONE CREEK CIR
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City | MABLETON
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State | GA
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Zip | 30126-2654
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Country | US
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Telephone | 931-241-1159
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Fax |
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Provider Business Mailing Address
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Address Line | 5908 COBBLESTONE CREEK CIR
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City | MABLETON
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State | GA
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Zip | 30126-2654
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Country | US
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Telephone | 931-241-1159
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Fax |
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Authorized Official
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Title or Position | CEO/OCCUPATIONAL THERAPIST
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Name | THOMAS LONG
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Credential | OTR/L
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Telephone | 931-241-1159
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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 |
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License Number State |
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