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General NPI Number Information
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NPI Number | 1821637323
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Entity Type | Organization
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Legal Business Name | MILESTONE MARKER THERAPY CLUB
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 747 OVERLOOK GLEN DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-3306
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Country | US
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Telephone | 404-736-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 871 SUNSET PARK DR
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City | SUWANEE
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State | GA
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Zip | 30024-5530
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NADIA FOFANA
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Credential |
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Telephone | 470-736-2828
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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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