Provider Demographics
NPI:1447827605
Name:WESSON PEDIATRIC THERAPY LLC
Entity type:Organization
Organization Name:WESSON PEDIATRIC THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS,OTR/L
Authorized Official - Phone:770-329-4165
Mailing Address - Street 1:4158 MILLHOUSE LN
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CORNERS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2110
Mailing Address - Country:US
Mailing Address - Phone:770-329-4165
Mailing Address - Fax:770-847-8112
Practice Address - Street 1:4158 MILLHOUSE LN
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-3009
Practice Address - Country:US
Practice Address - Phone:770-847-9838
Practice Address - Fax:770-847-8112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty