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General NPI Number Information
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NPI Number | 1902730112
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Entity Type | Organization
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Legal Business Name | EMPOWER RECREATIONAL THERAPY, LLC
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 1632 TAPPAHANNOCK TRL
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City | MARIETTA
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State | GA
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Zip | 30062-2088
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Country | US
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Telephone | 717-793-0687
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Fax | 855-717-1948
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Provider Business Mailing Address
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Address Line | PO BOX 965501
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City | MARIETTA
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State | GA
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Zip | 30066-0009
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Country | US
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Telephone | 717-793-0687
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Fax | 855-717-1948
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Authorized Official
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Title or Position | OWNER
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Name | LAURA KELLY
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Credential | MS, CTRS, FDRT
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Telephone | 717-793-0673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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