Provider Demographics
NPI:1104877117
Name:SOUTHERN OCCUPATIONAL THERAPY SERVICES, INC.
Entity type:Organization
Organization Name:SOUTHERN OCCUPATIONAL THERAPY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:770-401-0296
Mailing Address - Street 1:9800 HUTCHESON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-2317
Mailing Address - Country:US
Mailing Address - Phone:770-401-0296
Mailing Address - Fax:770-463-5398
Practice Address - Street 1:9800 HUTCHESON FERRY RD
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-2317
Practice Address - Country:US
Practice Address - Phone:770-401-0296
Practice Address - Fax:770-463-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001002225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty