Organization
MANELY KIDS
Active
Organization
MANELY KIDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNETTE M CRENSHAW (EXECUTIVE DIRECTOR)
(678) 923-1088
Entity
Organization
Contact information
Practice address
347 ARNOLD MILL RD, WOODSTOCK, GA 30188-2835
(678) 923-1088
Mailing address
215 JEP WHEELER RD, WOODSTOCK, GA 30188-6501
(678) 923-1088
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
0614616
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
720022501A
—
GA
Enumeration date
02/08/2010
Last updated
02/08/2010
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