Organization
FUNDAMENTAL THERAPY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JENNIFER MARIE DESLICH MS, OTR/L (OWNER)
(678) 357-5849
Entity
Organization
Contact information
Practice address
165 RIDGECREST CIR, CLAYTON, GA 30525-4110
(678) 357-5849
Mailing address
4649 E WOLF CREEK RD, TIGER, GA 30576-2946
(678) 357-5849
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003141022E
—
GA
Enumeration date
05/04/2017
Last updated
10/30/2023
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