=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700226750
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTS AND HANDS THERAPY SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2013
-----------------------------------------------------
Last Update Date | 07/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4500 HUGH HOWELL RD SUITE 780
-----------------------------------------------------
City | TUCKER
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30084-4723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-462-1342
-----------------------------------------------------
Fax | 678-493-9464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 709 CRESCENT CIR
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30115-4772
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-462-1342
-----------------------------------------------------
Fax | 678-493-9464
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, OWNER
-----------------------------------------------------
Name | AMY UTECHT
-----------------------------------------------------
Credential | MS, OTR/L
-----------------------------------------------------
Telephone | 678-462-1342
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251P0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------