Provider Demographics
NPI:1932295433
Name:OUR CHILDREN THERAPY SERVICES
Entity Type:Organization
Organization Name:OUR CHILDREN THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSPT
Authorized Official - Prefix:
Authorized Official - First Name:OLYMPHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-715-1544
Mailing Address - Street 1:PO BOX 6867
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0032
Mailing Address - Country:US
Mailing Address - Phone:678-715-1544
Mailing Address - Fax:
Practice Address - Street 1:4352 MISSOULA PL
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-8608
Practice Address - Country:US
Practice Address - Phone:678-715-1544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0075802251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty