Provider Demographics
NPI:1689751380
Name:OT JUST FOR KIDS, LLC
Entity Type:Organization
Organization Name:OT JUST FOR KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARYSE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHER-GODBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-385-8191
Mailing Address - Street 1:65 ROSE WALK DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7712
Mailing Address - Country:US
Mailing Address - Phone:770-385-8191
Mailing Address - Fax:770-385-8191
Practice Address - Street 1:65 ROSE WALK DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7712
Practice Address - Country:US
Practice Address - Phone:770-385-8191
Practice Address - Fax:770-385-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003086225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000878039DMedicaid