1194054056 NPI number — DEVELOPMENTAL THERAPY ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194054056 NPI number — DEVELOPMENTAL THERAPY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENTAL THERAPY ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194054056
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 DAME KATHRYN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31411-1603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-598-2740
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 OGLETHORPE PROFESSIONAL CT STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31406-3693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-351-4793
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
BECKLER
Authorized Official First Name:
MYRA
Authorized Official Middle Name:
SMITH
Authorized Official Title or Position:
OCCUPATIONAL THERAPY
Authorized Official Telephone Number:
912-598-2740

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  OT004219 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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