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NPI Code Detail

MEDICARE: MCKENNA FARMS THERAPY SERVICES

MEDICARE: MCKENNA FARMS THERAPY SERVICES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225XP0200XPediatric Occupational TherapistOT004432GA

General Provider Information

NPI Number : 1073709002
Entity Type Code : Organization
Provider Name (Legal Business Name) : MCKENNA FARMS THERAPY SERVICES
Provider Business Mailing Address
First Line : 3044 DUE WEST RD
Second Line :
City : DALLAS
State : GA
Zip : 30157-2125
Country : US
Telephone Number : 770-443-9672
Fax Number : 770-505-3595
Provider Business Practice Location Address
First Line : 3044 DUE WEST RD
Second Line :
City : DALLAS
State : GA
Zip : 30157-2125
Country : US
Telephone Number : 770-443-9672
Fax Number : 770-505-3595
Authorized Official
Title or Position : BILLING ADMINISTRATOR
Name : MRS. CHERYL ZIEGLER
Credential :
Telephone Number : 770-432-8996
Provider Enumeration Date : 09/24/2007
Last Update Date : 09/24/2007

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Directions to “MCKENNA FARMS THERAPY SERVICES ” Practice Location

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