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General NPI Number Information
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NPI Number | 1902305865
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Entity Type | Organization
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Legal Business Name | ACHELOIS, LLC
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Dates
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Enumeration Date | 02/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 3540 WHEELER RD STE 508
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City | AUGUSTA
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State | GA
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Zip | 30909
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Country | US
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Telephone | 706-364-3507
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Fax |
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Provider Business Mailing Address
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Address Line | 3314 SE 22ND AVE
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City | CAPE CORAL
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State | FL
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Zip | 33904-4421
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Country | US
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Telephone | 239-540-2725
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY KATHLEEN ROBBINS-KRALAPP
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Credential | RN JD
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Telephone | 239-471-0116
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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 | OT005909
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License Number State | GA
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