Organization
FUNCTIONAL VITALITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATESS ECHAVARRIA OT (OWNER)
(470) 266-0623
Entity
Organization
Contact information
Practice address
2375 WALL ST SE STE 240, CONYERS, GA 30013-6702
(678) 278-8348
(470) 276-3158
Mailing address
680 GRANDVIEW RD, MANSFIELD, GA 30055-2571
(470) 266-0623
(470) 276-3158
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
Other
Enumeration date
06/10/2022
Last updated
06/16/2022
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