Organization
KIDS CREEK THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRLAINE DARIUS (ADMIN DIRECTOR)
(770) 888-5221
Entity
Organization
Contact information
Practice address
4055 JOHNS CREEK PKWY STE A, SUWANEE, GA 30024-1299
(770) 888-5221
(678) 680-5929
Mailing address
4055 JOHNS CREEK PKWY STE A, SUWANEE, GA 30024-1299
(770) 888-5221
(678) 680-5929
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
106S00000X
Behavior Technician
—
—
225100000X
Physical Therapist
PT008420
GA
225100000X
Physical Therapist
PT008827
GA
225X00000X
Occupational Therapist
OT001067
GA
225X00000X
Occupational Therapist
OT001466
GA
225X00000X
Occupational Therapist
OT003625
GA
225X00000X
Occupational Therapist
OT003747
GA
235Z00000X
Speech-Language Pathologist
SLP004267
GA
235Z00000X
Speech-Language Pathologist
SLP004972
GA
235Z00000X
Speech-Language Pathologist
SLP005105
GA
235Z00000X
Speech-Language Pathologist
SLP005895
GA
235Z00000X
Speech-Language Pathologist
SLP006187
GA
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
09/20/2006
Last updated
10/02/2023
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