Provider Demographics
NPI:1346751690
Name:QUALITY OF LIFE THERAPY ASSOCIATES
Entity Type:Organization
Organization Name:QUALITY OF LIFE THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SLP/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DENNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:470-377-3980
Mailing Address - Street 1:7483 SILVER ARROW TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30168-2402
Mailing Address - Country:US
Mailing Address - Phone:404-895-9581
Mailing Address - Fax:
Practice Address - Street 1:7483 SILVER ARROW TRL
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30168-2402
Practice Address - Country:US
Practice Address - Phone:470-377-3980
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-13
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty