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General NPI Number Information
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NPI Number | 1912432261
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Entity Type | Organization
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Legal Business Name | ASPIRE PEDIATRIC THERAPY OF GA, LLC
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Dates
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Enumeration Date | 04/25/2017
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 7367 SPOUT SPRINGS RD SUITE 125
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-5519
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Country | US
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Telephone | 770-965-1861
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Fax |
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Provider Business Mailing Address
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Address Line | 7367 SPOUT SPRINGS RD SUITE 125
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City | FLOWERY BRANCH
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State | GA
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Zip | 30542-5519
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Country | US
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Telephone | 770-965-1861
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARGARET VAN BUREN
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Credential | OTR/L, SIPT
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Telephone | 770-965-1861
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA002233
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License Number State | GA
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