Provider Demographics
NPI:1598386682
Name:CIRCLE OF LIFE THERAPY & CONSULTING LLC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE THERAPY & CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOWDRE
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:770-866-1794
Mailing Address - Street 1:3572 PRESERVATION CIR
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2072
Mailing Address - Country:US
Mailing Address - Phone:770-866-1794
Mailing Address - Fax:
Practice Address - Street 1:3572 PRESERVATION CIR
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2072
Practice Address - Country:US
Practice Address - Phone:770-866-1794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty