Fundamental Therapy Services, LLC
Organization Active NPI Occupational Therapist · Clayton, GA
NPI 1780110155 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1780110155
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Occupational Therapist 225X00000X
- Legal business name
- FUNDAMENTAL THERAPY SERVICES, LLC
- Practice address
- 165 Ridgecrest Cir
Clayton, GA 30525-4110 - Phone
- (678) 357-5849
- NPI assigned
- May 4, 2017
- Organization subpart
- No
Authorized official
- Name
- Mrs. Jennifer Marie Deslich, MS, OTR/L
- Title
- Owner
- Phone
- (678) 357-5849
Practitioners 12
-
Jamie Blake, OT
-
Jennifer Deslich, O.T.
-
Destiny Miller Mangan, M.S. CCC-SLP
-
Haley Arrendale White, PT, DPT
-
Kaitlyn Howell, PT, DPT
-
Anne Reed Rickman, M.ED., CCC-SLP
-
Kayla Nicole Parker, MS, OTR/L
-
Emily Nonnemaker Brackett, MS, OTR/L
-
Ashley D. Miller, OTR/L
-
Jamie Lynn Nash, MS, OTR/L
-
Rachel Toscano, M.S CCC-SLP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20181011002104 | GA | Part B Supplier - Clinic/Group Practice | 4789936113 |
Receives reassigned benefits from 4 practitioners Practice locations: Clayton, GA |
National Provider Directory
Locations
165 Ridgecrest Cir
Clayton, GA 30525
Phone (678) 357-5849
165 Ridgecrest Cir
Ste B
Clayton, GA 30525
Phone (678) 357-5849
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist |
225X00000X | Yes |
Addresses
Primary practice location
165 Ridgecrest Cir
Clayton, GA 30525-4110
Mailing address
4649 E Wolf Creek Rd
Tiger, GA 30576-2946
Phone (678) 357-5849
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003141022E | Medicaid | GA |
Other providers in Clayton, GA
- Foothills Emergency Services, LLC
- Karen J Frank
- Edward Dent Frederickson
- Suzanne A Frederickson
- Louis Peter Fuerstman
- Wesley Turner Funk
- Gainesville Physical Therapy-Clayton
- Cortney Morgan Galloway
- Nathan Gregory Gay
- Georgia CVS Pharmacy LLC
All providers in Clayton, GA · Occupational Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.