Provider Demographics
NPI:1073709002
Name:MCKENNA FARMS THERAPY SERVICES
Entity Type:Organization
Organization Name:MCKENNA FARMS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIEGLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-432-8996
Mailing Address - Street 1:3044 DUE WEST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2125
Mailing Address - Country:US
Mailing Address - Phone:770-443-9672
Mailing Address - Fax:770-505-3595
Practice Address - Street 1:3044 DUE WEST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-2125
Practice Address - Country:US
Practice Address - Phone:770-443-9672
Practice Address - Fax:770-505-3595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004432225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty