Organization
EARTHSHINE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA LEAH MIRANDY (OWNER)
(770) 546-5184
Entity
Organization
Contact information
Practice address
29 TOPRIDGE DR, CARTERSVILLE, GA 30120-6188
(770) 546-5184
Mailing address
29 TOPRIDGE DR, CARTERSVILLE, GA 30120-6188
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004855
GA
Other
Enumeration date
02/11/2017
Last updated
02/11/2017
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