Provider Demographics
NPI:1154521870
Name:PEDIATRIC HAND AND UPPER EXTREMITY REHABILITATION
Entity type:Organization
Organization Name:PEDIATRIC HAND AND UPPER EXTREMITY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:JULIET
Authorized Official - Last Name:STEFFE
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, CHT
Authorized Official - Phone:770-241-3483
Mailing Address - Street 1:2534 ALLSBOROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-8517
Mailing Address - Country:US
Mailing Address - Phone:770-241-3483
Mailing Address - Fax:
Practice Address - Street 1:2534 ALLSBOROUGH WAY
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-8517
Practice Address - Country:US
Practice Address - Phone:770-241-3483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003068251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA330681270AMedicaid