Provider Demographics
NPI:1730421066
Name:OCCUPATIONAL THERAPY OF FORSYTH
Entity type:Organization
Organization Name:OCCUPATIONAL THERAPY OF FORSYTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-889-8852
Mailing Address - Street 1:4080 MCGINNIS FERRY RD
Mailing Address - Street 2:BLDG. 300, STE.302
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3948
Mailing Address - Country:US
Mailing Address - Phone:770-410-7719
Mailing Address - Fax:770-410-9510
Practice Address - Street 1:4080 MCGINNIS FERRY RD
Practice Address - Street 2:BLDG. 300, STE.302
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:770-410-7719
Practice Address - Fax:770-410-9510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty