Provider Demographics
NPI:1104099134
Name:RISING STARS CHILDREN'S THERAPY, INC
Entity type:Organization
Organization Name:RISING STARS CHILDREN'S THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:770-345-2804
Mailing Address - Street 1:9880 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3081
Mailing Address - Country:US
Mailing Address - Phone:770-345-2804
Mailing Address - Fax:770-783-5049
Practice Address - Street 1:9880 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3081
Practice Address - Country:US
Practice Address - Phone:770-345-2804
Practice Address - Fax:770-783-5049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2251P0200X, 225XP0200X, 235Z00000X
GAOT003297261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty