Provider Demographics
NPI:1215190368
Name:MOMENTUM THERAPY ASSOCIATES, L.L.C.
Entity Type:Organization
Organization Name:MOMENTUM THERAPY ASSOCIATES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/C
Authorized Official - Phone:251-379-2233
Mailing Address - Street 1:4520 CREEKSIDE CV
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-3957
Mailing Address - Country:US
Mailing Address - Phone:251-379-2233
Mailing Address - Fax:
Practice Address - Street 1:4520 CREEKSIDE CV
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-3957
Practice Address - Country:US
Practice Address - Phone:251-379-2233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004293225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty