Organization
THERA-CORE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARRYL S PIPKIN OTR/L (PRESIDENT)
(404) 457-3256
Entity
Organization
Contact information
Practice address
1313 WELLESLEY PL, RIVERDALE, GA 30296-2972
(404) 457-3256
Mailing address
1313 WELLESLEY PL, RIVERDALE, GA 30296-2972
(404) 457-3256
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
Primary
—
—
235Z00000X
Speech-Language Pathologist
—
—
251E00000X
Home Health Agency
—
—
310400000X
Assisted Living Facility
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
01/25/2023
Last updated
04/20/2023
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