Organization
ESSENTIAL THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TINA BLACK (CO OWNER)
(678) 679-1261
Entity
Organization
Contact information
Practice address
4640 MARTIN ROAD, SUITE 300, CUMMING, GA 30041
(678) 679-1261
Mailing address
4640 MARTIN RD, CUMMING, GA 30041-5542
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005165
GA
Other
Enumeration date
10/05/2010
Last updated
10/11/2010
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