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General NPI Number Information
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NPI Number | 1568697613
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Entity Type | Organization
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Legal Business Name | PEDIATRIC THERAPY PARTNERS OF WGA
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 121B LEE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-3314
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Country | US
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Telephone | 770-830-8622
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Fax | 770-832-9031
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Provider Business Mailing Address
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Address Line | 121B LEE ST
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City | CARROLLTON
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State | GA
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Zip | 30117-3314
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Country | US
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Telephone | 770-830-8622
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Fax | 770-832-9031
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | SHEILA DENNEY
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Credential | OT
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Telephone | 770-830-8622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT007533
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | OT001282
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License Number State | GA
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