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General NPI Number Information
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NPI Number | 1609426188
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Entity Type | Organization
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Legal Business Name | RESTORE WELLNESS AND PAIN MANAGEMENT CENTER
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 1324 GATES CIR SE
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City | ATLANTA
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State | GA
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Zip | 30316-4092
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Country | US
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Telephone | 678-598-2095
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Fax | 678-669-2652
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Provider Business Mailing Address
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Address Line | 1324 GATES CIR SE
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City | ATLANTA
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State | GA
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Zip | 30316-4092
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Country | US
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Telephone | 678-598-2095
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Fax | 678-669-2652
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST
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Name | CYNTHIA PEARSON
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Credential | MS, OTR/L
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Telephone | 678-598-2095
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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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