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General NPI Number Information
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NPI Number | 1922590892
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Entity Type | Organization
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Legal Business Name | INSIDE OUT THERAPY SERVICES
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Dates
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Enumeration Date | 06/05/2018
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Last Update Date | 06/25/2018
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Provider Practice Location Address
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Address Line | 1450 EDEN AVE
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City | BOGART
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State | GA
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Zip | 30622
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Country | US
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Telephone | 770-634-5594
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 EDEN AVE
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City | BOGART
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State | GA
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Zip | 30622-3365
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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 | THERAPIST
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Name | SARON DANIEL
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Credential | OTR/L
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Telephone | 770-634-5594
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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 | OT007058
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License Number State | GA
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