Organization
PEDIATRIC THERAPIES OF SE GA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN MICHELLE PARKS (OWNER/OPERATOR/PROVIDER)
(912) 996-2069
Entity
Organization
Contact information
Practice address
1204 HOSPITALITY AVE, SUITE E, KINGSLAND, GA 31548-6810
(912) 996-2069
(912) 265-0041
Mailing address
5200 SAN JOSE BLVD, UNIT 7, JACKSONVILLE, FL 32207-1905
(912) 996-2069
(912) 265-0041
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT001375
GA
Other
Enumeration date
02/12/2016
Last updated
02/03/2017
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