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NPI Code Detail

MEDICARE: ALLISON CHESHIRE THOR MHS, OTR/L, ATC, LAT

MEDICARE: ALLISON CHESHIRE THOR MHS, OTR/L, ATC, LAT
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
12255A2300XAthletic TrainerAT003254GA
2225X00000XOccupational TherapistOT007492GA

General Provider Information

NPI Number : 1760032718
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALLISON CHESHIRE THOR MHS, OTR/L, ATC, LAT
Provider Business Mailing Address
First Line : 404 WOOD DALE DR
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3352
Country : US
Telephone Number : 912-690-4344
Fax Number :
Provider Business Practice Location Address
First Line : 475 S MAIN ST
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-4312
Country : US
Telephone Number : 912-368-4131
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2019
Last Update Date : 09/11/2019

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