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NPI Code Detail

MEDICARE: RISING STARS CHILDREN'S THERAPY, INC

MEDICARE: RISING STARS CHILDREN'S THERAPY, INC
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
12251P0200XPediatric Physical Therapist
2225XP0200XPediatric Occupational Therapist
3235Z00000XSpeech-Language Pathologist
4261QR0400XRehabilitation Clinic/CenterOT003297GA

General Provider Information

NPI Number : 1104099134
Entity Type Code : Organization
Provider Name (Legal Business Name) : RISING STARS CHILDREN'S THERAPY, INC
Provider Business Mailing Address
First Line : 9880 HICKORY FLAT HWY
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-3081
Country : US
Telephone Number : 770-345-2804
Fax Number : 770-783-5049
Provider Business Practice Location Address
First Line : 9880 HICKORY FLAT HWY
Second Line :
City : WOODSTOCK
State : GA
Zip : 30188-3081
Country : US
Telephone Number : 770-345-2804
Fax Number : 770-783-5049
Authorized Official
Title or Position : OCCUPATIONAL THERAPIST
Name : MRS. KRISTI A. ESTES
Credential : OTR/L
Telephone Number : 770-345-2804
Provider Enumeration Date : 04/10/2008
Last Update Date : 01/04/2018

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