Provider Demographics
NPI:1356760318
Name:SPECIALIZED THERAPY SOLUTIONS, LLC
Entity type:Organization
Organization Name:SPECIALIZED THERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANIKA
Authorized Official - Middle Name:MCCLAIN
Authorized Official - Last Name:QUEEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:404-502-7997
Mailing Address - Street 1:1494 HAMPTON VIEW CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-4094
Mailing Address - Country:US
Mailing Address - Phone:404-502-7997
Mailing Address - Fax:404-566-6080
Practice Address - Street 1:1494 HAMPTON VIEW CT
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30008-4094
Practice Address - Country:US
Practice Address - Phone:404-502-7997
Practice Address - Fax:404-566-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004369302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization