Provider Demographics
NPI:1124649173
Name:SAWDUST OCCUPATIONAL THERAPY
Entity type:Organization
Organization Name:SAWDUST OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:HOUSTON
Authorized Official - Last Name:KEELING
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:678-697-2932
Mailing Address - Street 1:11660 ALPHARETTA HWY STE 400
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4965
Mailing Address - Country:US
Mailing Address - Phone:404-436-7416
Mailing Address - Fax:
Practice Address - Street 1:11660 ALPHARETTA HWY STE 400
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4965
Practice Address - Country:US
Practice Address - Phone:404-436-7416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty