Provider Demographics
NPI:1639301567
Name:ASPIRE PEDIATRIC THERAPY OF GEORGIA, LLC
Entity Type:Organization
Organization Name:ASPIRE PEDIATRIC THERAPY OF GEORGIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:T
Authorized Official - Last Name:VAN BUREN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L, ATP, SIPT
Authorized Official - Phone:770-965-1861
Mailing Address - Street 1:5745 OLD WINDER HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-1636
Mailing Address - Country:US
Mailing Address - Phone:770-965-1861
Mailing Address - Fax:770-965-1863
Practice Address - Street 1:5745 OLD WINDER HWY
Practice Address - Street 2:SUITE C
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-1636
Practice Address - Country:US
Practice Address - Phone:770-965-1861
Practice Address - Fax:770-965-1863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-11
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004005225XP0200X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty