Provider Demographics
NPI:1194054056
Name:DEVELOPMENTAL THERAPY ASSOCIATES
Entity type:Organization
Organization Name:DEVELOPMENTAL THERAPY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYRA
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:BECKLER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:912-598-2740
Mailing Address - Street 1:39 DAME KATHRYN DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31411-1603
Mailing Address - Country:US
Mailing Address - Phone:912-598-2740
Mailing Address - Fax:
Practice Address - Street 1:106 OGLETHORPE PROFESSIONAL CT STE A
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3693
Practice Address - Country:US
Practice Address - Phone:912-351-4793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004219261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation