Provider Demographics
NPI:1407986169
Name:EAST COBB HAND THERAPY LLC
Entity Type:Organization
Organization Name:EAST COBB HAND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:OTR CHT
Authorized Official - Phone:770-578-4334
Mailing Address - Street 1:3901 ROSWELL RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6284
Mailing Address - Country:US
Mailing Address - Phone:770-578-4334
Mailing Address - Fax:770-578-4335
Practice Address - Street 1:3901 ROSWELL RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6284
Practice Address - Country:US
Practice Address - Phone:770-578-4334
Practice Address - Fax:770-578-4335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000542225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA990037399AMedicaid
GAGRP6544OtherMEDICARE GROUP #
GA1073563771OtherINDIVIDUAL NPI #
GA1407986169OtherGROUP NPI
GAGRP6544OtherMEDICARE GROUP #
GA67BBBKBMedicare ID - Type Unspecified# FOR OT
GA990037399AMedicaid