Provider Demographics
NPI:1952970113
Name:ATLANTA KIDS THERAPY, LLC
Entity Type:Organization
Organization Name:ATLANTA KIDS THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIRALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:440-665-7965
Mailing Address - Street 1:1843 SHENLEY PARK LN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4922
Mailing Address - Country:US
Mailing Address - Phone:440-665-7965
Mailing Address - Fax:
Practice Address - Street 1:1843 SHENLEY PARK LN
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-4922
Practice Address - Country:US
Practice Address - Phone:440-665-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003233229AMedicaid