Provider Demographics
NPI:1275773152
Name:THE PEDIATRIC THERAPY CLINIC, INC.
Entity Type:Organization
Organization Name:THE PEDIATRIC THERAPY CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SCHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:770-218-2300
Mailing Address - Street 1:5150 STILESBORO RD NW STE 410
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7759
Mailing Address - Country:US
Mailing Address - Phone:770-218-2300
Mailing Address - Fax:
Practice Address - Street 1:5150 STILESBORO RD NW STE 410
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7759
Practice Address - Country:US
Practice Address - Phone:770-218-2300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency