| Functional Vitality | |
|
2375 Wall St Se Ste 240, Conyers, GA 30013-6702 | |
| (678) 278-8348 | |
| (470) 276-3158 |
| Full Name | Functional Vitality |
|---|---|
| Type | Facility |
| Speciality | Occupational Therapist |
| Location | 2375 Wall St Se Ste 240, Conyers, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497484778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | (* (Not Available)) | Primary |
| 261QR0400X | Clinic/center - Rehabilitation | (* (Not Available)) | Secondary |
| Provider Name | Latess Ashley Nikki Echavarria |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1013457084 PECOS PAC ID: 5698009363 Enrollment ID: I20190629000009 |
| Mailing Address | Practice Location Address |
|---|---|
| Functional Vitality 680 Grandview Rd, Mansfield, GA 30055-2571 Ph: (470) 266-0623 | Functional Vitality 2375 Wall St Se Ste 240, Conyers, GA 30013-6702 Ph: (678) 278-8348 |
Mrs. Latricia Lashane Williams, OTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1504 Renaissance Dr Ne, Conyers, GA 30012 Phone: 404-421-2570 | |
Courtney Mills, OT Occupational Therapist Medicare: Accepting Medicare Assignments Practice Location: 1603 Highway 20 Ne, Suite 201, Conyers, GA 30012 Phone: 770-919-8411 Fax: 770-919-1419 | |
Progress Village Pediatric Therapy Services Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 2949 Sonecrest Pt, Conyers, GA 30094 Phone: 404-932-3440 Fax: 770-483-3955 | |
Kendra Wade, OTR/L Occupational Therapist Medicare: May Accept Medicare Assignments Practice Location: 1564 Callaway Loop, Conyers, GA 30012 Phone: 404-438-2671 | |
Mr. John Terrence Lewis Ii, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 2305 Red Maple Ct Se, Conyers, GA 30013 Phone: 678-549-1487 | |
Charles Edward Berstecher, OTR/L, ATP, CAPS Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 2135 Teri Ln Se, Conyers, GA 30013 Phone: 404-921-8363 | |
Camille Mckenzie, Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 2395 Wall St Se Ste 290, Conyers, GA 30013 Phone: 470-725-2509 |