Provider Demographics
NPI:1700205697
Name:SIMPLE ESSENTIAL THERAPY SERVICE,LLC
Entity Type:Organization
Organization Name:SIMPLE ESSENTIAL THERAPY SERVICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTA
Authorized Official - Middle Name:TORREY'S
Authorized Official - Last Name:BRAZILE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:404-667-5158
Mailing Address - Street 1:91 BARRINGTON FARMS PKWY
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-1853
Mailing Address - Country:US
Mailing Address - Phone:404-667-5158
Mailing Address - Fax:
Practice Address - Street 1:91 BARRINGTON FARMS PKWY
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-1853
Practice Address - Country:US
Practice Address - Phone:404-667-5158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2440251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GANPI1346673464OtherNPI INDIVIDUAL NUMBER