Organization
MOTOR MOUTH THERAPY, LLC
Active
Other names
Motor Mouth Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA P GOMEZ MS-CCC-SLP (OWNER/DIRECTOR)
(678) 820-9606
Entity
Organization
Contact information
Practice address
4530 NELSON BROGDON BLVD STE C, BUFORD, GA 30518-5407
(678) 820-9606
(844) 820-9616
Mailing address
4530 NELSON BROGDON BLVD STE C, BUFORD, GA 30518-5407
(678) 820-9606
(844) 820-9616
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
006456
GA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003134692A
—
GA
05
—
198576913D
—
GA
Enumeration date
09/05/2013
Last updated
04/21/2022
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