Organization
PEDIATRIC THERAPIES OF SE GA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN MICHELLE PARKS MS, OTR/L (CEO)
(912) 342-8875
Entity
Organization
Contact information
Practice address
4212 CORAL PARK DR, BRUNSWICK, GA 31520-3016
(912) 342-8875
(912) 265-0041
Mailing address
4212 CORAL PARK DR, BRUNSWICK, GA 31520-3016
(912) 342-8875
(912) 265-0041
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
OT001375
GA
225XP0200X
Pediatric Occupational Therapist
OT002198
GA
225XP0200X
Pediatric Occupational Therapist
OT005680
GA
235Z00000X
Speech-Language Pathologist
SLP001592
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003116394B
—
GA
Enumeration date
11/14/2011
Last updated
06/19/2019
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