MEDICARE: REVIVE & THRIVE HEALTHCARE LLC

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
1	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1962344374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REVIVE & THRIVE HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	3343 PEACHTREE RD NE
Second Line	:	STE 180 #A2083
City	:	ATLANTA
State	:	GA
Zip	:	30326-1085
Country	:	US
Telephone Number	:	404-975-4219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3343 PEACHTREE RD NE
Second Line	:	STE 180 A#A2083
City	:	ATLANTA
State	:	GA
Zip	:	30326-1085
Country	:	US
Telephone Number	:	404-975-4219
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL THERAPIST
Name	:	CHATHAM CARTER
Credential	:	OTR/L
Telephone Number	:	770-545-2184

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/24/2026

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