Provider Demographics
NPI:1790747962
Name:TOTS, INC.
Entity Type:Organization
Organization Name:TOTS, INC.
Other - Org Name:KIDDOS' CLUBHOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:DEVORE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OTR/L
Authorized Official - Phone:678-527-3224
Mailing Address - Street 1:11539 PARK WOODS CIR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4413
Mailing Address - Country:US
Mailing Address - Phone:678-527-3224
Mailing Address - Fax:678-366-5886
Practice Address - Street 1:11539 PARK WOODS CIR
Practice Address - Street 2:SUITE 502
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4413
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:678-366-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002774225XP0200X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q14265Medicare UPIN
GAGRP6413Medicare ID - Type Unspecified