Provider Demographics
NPI:1972072866
Name:RDSD OCCUPATIONAL THERAPY SERVICES LLC
Entity type:Organization
Organization Name:RDSD OCCUPATIONAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:D'ANGELO
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:770-880-3882
Mailing Address - Street 1:263 LAUREL TOP RDG
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30536-4156
Mailing Address - Country:US
Mailing Address - Phone:770-880-3882
Mailing Address - Fax:278-678-0963
Practice Address - Street 1:263 LAUREL TOP RDG
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-4156
Practice Address - Country:US
Practice Address - Phone:770-880-3882
Practice Address - Fax:278-678-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003153016BMedicaid