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General NPI Number Information
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NPI Number | 1932295433
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Entity Type | Organization
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Legal Business Name | OUR CHILDREN THERAPY SERVICES
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4352 MISSOULA PL
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-8608
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Country | US
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Telephone | 678-715-1544
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6867
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City | DOUGLASVILLE
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State | GA
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Zip | 30154-0032
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Country | US
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Telephone | 678-715-1544
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Fax |
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Authorized Official
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Title or Position | MSPT
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Name | OLYMPHIA A JACKSON
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Credential |
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Telephone | 678-715-1544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | PT007580
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License Number State | GA
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