Provider Demographics
NPI:1821262577
Name:OCCUPATIONAL REHAB SERVICES
Entity Type:Organization
Organization Name:OCCUPATIONAL REHAB SERVICES
Other - Org Name:MELINDA L COLEMAN
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:706-495-2528
Mailing Address - Street 1:815 WALDEN GLEN LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3144
Mailing Address - Country:US
Mailing Address - Phone:706-495-2528
Mailing Address - Fax:706-364-2518
Practice Address - Street 1:815 WALDEN GLEN LN
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3144
Practice Address - Country:US
Practice Address - Phone:706-495-2528
Practice Address - Fax:706-364-2518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005606225100000X
GAOT003551225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA39210989AMedicaid
SCTH1245Medicaid