AEGIS GROUP PRACTICE, LLC (NPI# 1841731569) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841731569 |
| Entity Type | Organization |
| Organization Name | AEGIS GROUP PRACTICE, LLC |
| Practice Address |
3385 Trickum Rd Woodstock GA 30188-4234 |
| Mailing Address |
1000 Fianna Way # Md4843 Fort Smith AR 72919-9008 |
| Practice Telephone | 4792012000 |
| Practice Fax Number | 4792014801 |
| Mailing Telephone | 4792012000 |
| Mailing Fax Number | 4792014801 |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2017-03-14 |
| Authorized Official Name | MIKE MCOLVIN (DIRECTOR) |
| Authorized Official Telephone | 4792012000 |
| Is Organization Subpart | Y |
| Parent Organization Name | AEGIS THERAPIES, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| N | 235Z00000X | Speech-Language Pathologist | Speech, Language and Hearing Service Providers | ||
| Y | 225X00000X | Occupational Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124527189 | Aegis Group Practice, LLC | Physical Therapist | 2500 Aaron Street, Port Charlotte, FL 33952 | 2018-02-06 |
| 1841705985 | Aegis Group Practice, LLC | Occupational Therapist | 4401 Shallowford Rd Ste 158, Roswell, GA 30075-3175 | 2017-12-12 |
| 1063927879 | Aegis Group Practice, LLC | Occupational Therapist | 999 Crosswater Pkwy, Ponte Vedra, FL 32081-0891 | 2017-12-04 |
| 1538600226 | Aegis Group Practice, LLC | Physical Therapist | 2100 Johnston Dr, Raymore, MO 64083-8122 | 2017-03-14 |
| 1518408244 | Aegis Group Practice, LLC | Speech-Language Pathologist | 201 Evergreen Ter, Stockbridge, GA 30281-7375 | 2017-03-14 |
| 1720529423 | Aegis Group Practice, LLC | Physical Therapist | 7155 S Dearing Rd, Covington, GA 30014-7002 | 2017-03-14 |
| 1750822466 | Aegis Group Practice, LLC | Physical Therapist | 1701 Nw Jefferson St, Blue Springs, MO 64015-7229 | 2017-03-14 |
| 1538600259 | Aegis Group Practice, LLC | Physical Therapist | 4999 Prestley Mill Rd, Douglasville, GA 30135-1463 | 2017-03-14 |
| 1548700610 | Aegis Group Practice, LLC | Physical Therapist | 35 1st Ave N, Waite Park, MN 56387-1225 | 2017-03-08 |
| 1275073363 | Aegis Group Practice, LLC | Physical Therapist | W129n6889 Northfield Dr, Menomonee Falls, WI 53051-0518 | 2017-03-08 |
| Street Address |
3385 TRICKUM RD |
| City | WOODSTOCK |
| State | GA |
| Zip Code | 30188-4234 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144743105 | Kimber Gray | Speech-Language Pathologist | 3385 Trickum Rd, Woodstock, GA 30188-4234 | 2017-07-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730715814 | Tyler Rose | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 116 South Mill Creek Court, Woodstock, GA 30188 | 2020-03-20 |
| 1881224897 | Dr. Tom LLC | Clinic/Center | 5431 Old Highway 5 Ste 206, Holly Springs, GA 30188 | 2020-01-17 |
| 1467090175 | Stacey Robin Hill | Dietitian, Registered | 210 Mcaffee St, Street Address 2, Woodstock, GA 30188 | 2019-12-12 |
| 1326681784 | Margo Vanderveen | Massage Therapist | 605 Old Hickory Road, Woodstock, GA 30188 | 2019-10-17 |
| 1275093437 | Rebekah Ruth Tchouta | Social Worker | 5166 Shotwell St, Woodstock, GA 30188 | 2019-03-23 |
| 1205395829 | Angela M Graves | Behavior Technician | 3229 S Cherokee Ln Ste 1400, Woodstock, GA 30188 | 2019-03-13 |
| 1396233391 | Costco Wholesale Corporation | Hearing Aid Equipment | 113 Lincoln Street, Woodstock, GA 30188 | 2018-04-25 |
| 1659878080 | Alexis K. Brown | Counselor | 3380 Trickum Rd., Bldg 700, Woodstock, GA 30188 | 2018-04-11 |
| 1427555440 | Lisa Marie Anthony | Specialist/Technologist | 400 Arnold Mill Rd, Woodstock, GA 30188 | 2018-04-06 |
| 1497254122 | J.a.h. Enterprises, LLC | Audiologist | 12195 Hwy. 92, Suite 114-325, Woodstock, GA 30188 | 2018-02-08 |
| Find all providers in zip 30188 | ||||
| Taxonomy Code | 225X00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Occupational Therapist |
| An occupational therapist is a person who has graduated from an entry-level occupational therapy program accredited by the Accreditation Council for Occupational Therapy Education (ACOTE) or predecessor organizations, or approved by the World Federation of Occupational Therapists (WFOT), or an equivalent international occupational therapy education program; has successfully completed a period of supervised fieldwork experience required by the occupational therapy program; has passed a nationally recognized entry-level examination for occupational therapists, and fulfills state requirements for licensure, certification, or registration. An occupational therapist provides interventions based on evaluation and which emphasize the therapeutic use of everyday life activities (i.e., occupations) with individuals or groups for the purpose of facilitating participation in roles and situations and in home, school, workplace, community and other settings. Occupational therapy services are provided for the purpose of promoting health and wellness and are provided to those who have or are at risk for developing an illness, injury, disease, disorder, condition, impairment, disability, activity limitation, or participation restriction. Occupational therapists address the physical, cognitive, psychosocial, sensory, and other aspects of occupational performance in a variety of contexts to support engagement in everyday life activities that affect health, well-being, and quality of life. |
| Notes: Source: The Guide to Occupational Therapy Practice, 2nd edition. Bethesda: American Occupational Therapy Association, 2007. [7/1/2008: definition changed, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285246249 | Rachel Deonna Wiles | Occupational Therapist | 13291 Highway 92, Woodstock, GA 30188-4455 | 2020-08-20 |
| 1639794175 | Cayla Lucille Woodburn | Occupational Therapist | 306 Wind Ship Ct, Woodstock, GA 30189-5287 | 2020-06-10 |
| 1861024721 | Emily Arispe | Occupational Therapist | 310 Burdock Trce, Woodstock, GA 30188-7040 | 2020-02-09 |
| 1467082388 | Payton A Modarelli | Occupational Therapist | 1000 Professional Pkwy, Woodstock, GA 30188-3873 | 2020-01-20 |
| 1376044693 | Alyssa Beth Wienke | Occupational Therapist | 2990 Raffel Rd, Woodstock, IL 60098-8466 | 2018-02-22 |
| 1366987398 | Axis Therapy Solutions | Occupational Therapist | 211 Hartland Hill Rd, Woodstock, VT 05091-7925 | 2016-12-29 |
| 1174968143 | Kimberly Ratway | Occupational Therapist | 2914 S Country Club Rd, Woodstock, IL 60098-7101 | 2013-05-05 |
| 1700136231 | Jennifer Caupain | Occupational Therapist | 1314 Timuquana Trl, Woodstock, GA 30188-3633 | 2012-09-12 |
| 1154694248 | Cari Lynn Stilke | Occupational Therapist | 2211 Dean St, Woodstock, IL 60098-7658 | 2012-02-20 |
| 1477824639 | Devon Rogers | Occupational Therapist | 4580 Towne Lake Pkwy, Woodstock, GA 30189-5521 | 2012-01-19 |
| Find all providers in WOODSTOCK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.