Provider Demographics
NPI:1215671045
Name:NEXT STEP THERAPY SERVICES
Entity type:Organization
Organization Name:NEXT STEP THERAPY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LATODDIA
Authorized Official - Middle Name:SHEDOR
Authorized Official - Last Name:MAZE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:404-823-8437
Mailing Address - Street 1:3701 ROYER LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:GA
Mailing Address - Zip Code:30228-6068
Mailing Address - Country:US
Mailing Address - Phone:404-823-8437
Mailing Address - Fax:
Practice Address - Street 1:3701 ROYER LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:GA
Practice Address - Zip Code:30228-6068
Practice Address - Country:US
Practice Address - Phone:140-495-6441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA85-2909163Medicaid