Provider Demographics
NPI:1790055432
Name:TRAPEZE THERAPY, LLC
Entity Type:Organization
Organization Name:TRAPEZE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST / DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLYNN
Authorized Official - Middle Name:CORLEY
Authorized Official - Last Name:KENNA
Authorized Official - Suffix:
Authorized Official - Credentials:MS OTR/L
Authorized Official - Phone:706-340-3481
Mailing Address - Street 1:1141 THORNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-5342
Mailing Address - Country:US
Mailing Address - Phone:706-340-3481
Mailing Address - Fax:
Practice Address - Street 1:160 TRACY ST
Practice Address - Street 2:SUITE A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-1979
Practice Address - Country:US
Practice Address - Phone:706-340-3481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-11
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities