Provider Demographics
NPI:1821637323
Name:MOTIVATE THERAPY SERVICES
Entity Type:Organization
Organization Name:MOTIVATE THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFANA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:470-776-6979
Mailing Address - Street 1:871 SUNSET PARK DR
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5530
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3939 LAVISTA RD # E175
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5162
Practice Address - Country:US
Practice Address - Phone:470-776-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty