Provider Demographics
NPI:1568697613
Name:PEDIATRIC THERAPY PARTNERS OF WGA
Entity Type:Organization
Organization Name:PEDIATRIC THERAPY PARTNERS OF WGA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:770-830-8622
Mailing Address - Street 1:121B LEE ST
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3314
Mailing Address - Country:US
Mailing Address - Phone:770-830-8622
Mailing Address - Fax:770-832-9031
Practice Address - Street 1:121B LEE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3314
Practice Address - Country:US
Practice Address - Phone:770-830-8622
Practice Address - Fax:770-832-9031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0075332251P0200X
GAOT001282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA239574509DMedicaid
GA000609045EMedicaid
GA000675276EMedicaid