Provider Demographics
NPI:1952810566
Name:CHILDREN IN MOTION THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CHILDREN IN MOTION THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHAELENE
Authorized Official - Middle Name:SAGE
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:AO
Authorized Official - Phone:770-798-9844
Mailing Address - Street 1:5655 PEACHTREE PKWY STE 117
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2828
Mailing Address - Country:US
Mailing Address - Phone:770-798-9844
Mailing Address - Fax:770-798-9832
Practice Address - Street 1:5655 PEACHTREE PKWY STE 117
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092
Practice Address - Country:US
Practice Address - Phone:770-798-9844
Practice Address - Fax:770-798-9832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000954225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty