Organization
LIFESIGHT THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY MAINER OTR (OWNER/PROVIDER)
(770) 815-4590
Entity
Organization
Contact information
Practice address
1690 WINDSONG PARK DR, DACULA, GA 30019-1169
(770) 815-4590
Mailing address
1690 WINDSONG PARK DRIVE, DACULA, GA 30019-3262
(770) 815-4590
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002000
GA
Other
Enumeration date
09/27/2011
Last updated
09/17/2012
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