NPIMap

Organization Active NPI

Pediatric Therapies of SE Ga, LLC

  • Pediatric Occupational Therapist
  • Kingsland, GA
National Provider Identifier
1710346267
Registry record updated Feb 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Occupational TherapistTaxonomy code 225XP0200X
License
OT001375 Issued in GA
Legal business name
PEDIATRIC THERAPIES OF SE GA, LLC
Practice address
1204 Hospitality Ave
Suite E
Kingsland, GA 31548-6810
Phone
(912) 996-2069
Fax
(912) 265-0041
NPI assigned
Feb 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2017

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

Authorized official

Name
Karen Michelle ParksNPI 1932284403
Title
Owner/Operator/Provider
Phone
(912) 996-2069

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X OT001375 GA Primary

Addresses

Primary practice location

1204 Hospitality Ave
Suite E
Kingsland, GA 31548-6810

Mailing address

5200 San Jose Blvd
Unit 7
Jacksonville, FL 32207-1905
Phone (912) 996-2069

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Therapies of SE Ga2 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.

Locations

1204 Hospitality Ave
Ste E
Kingsland, GA 31548
Phone (912) 996-2069

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1455235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486080000000",
    "number": "1710346267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 SAN JOSE BLVD",
            "address_2": "UNIT 7",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322071905",
            "telephone_number": "912-996-2069",
            "fax_number": "912-265-0041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 HOSPITALITY AVE",
            "address_2": "SUITE E",
            "city": "KINGSLAND",
            "state": "GA",
            "postal_code": "315486810",
            "telephone_number": "912-996-2069",
            "fax_number": "912-265-0041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC THERAPIES OF SE GA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-02-12",
        "last_updated": "2017-02-03",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "OWNER/OPERATOR/PROVIDER",
        "authorized_official_telephone_number": "912-996-2069"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT001375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsland, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2017; 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.