Peach State Pediatric Therapy

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT004775 Issued in GA

Legal business name

PEACH STATE PEDIATRIC THERAPY

Practice address

4992 Bristol Industrial Way
Buford, GA 30518-1742

Phone

(770) 904-6419

Fax

(770) 904-6418

NPI assigned

Feb 5, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Margaret Ann Kuneyl, OTRL

Title

Ceo

Phone

(770) 904-6419

Specialties & licenses 1

Addresses

Tax ID family

Peach State Ped Therapy Buford2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peach State Pediatric Therapy Inc.

  • Specialist
  • Lawrenceville, GA
  • NPI 1073630992
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aundryel Breland, M.ED, CCC-SLP

  • Speech-Language Pathologist
  • Atlanta, GA
  • NPI 1558801969
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1454630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454630400000",
    "number": "1225496284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4992 BRISTOL INDUSTRIAL WAY",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181742",
            "telephone_number": "770-904-6419",
            "fax_number": "770-904-6418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4992 BRISTOL INDUSTRIAL WAY",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305181742",
            "telephone_number": "770-904-6419",
            "fax_number": "770-904-6418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEACH STATE PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-05",
        "last_updated": "2016-02-05",
        "status": "A",
        "authorized_official_last_name": "KUNEYL",
        "authorized_official_first_name": "MARGARET",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-904-6419",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OTRL"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT004775",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Romulus Pauline, AGPCNP-C
• Veronica Marie Pausa, MS, APC
• Larry Jason Payne, D.M.D.
• Mathew Peace, PT, DPT
• Peach State Care Partners
• Peachpoint Clinic
• Pearls Dentistry LLC (Pearls Dentistry)
• Bradley Douglass Pearson, ATC
• Shelly L. Peed, PHD
• McKenna Lynn Peffer

• Pediatric Occupational Therapist in Buford, GA
• Providers in Buford, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.