Provider Demographics
NPI:1053401190
Name:OCONEE REHABILITATION SERVICES INC
Entity type:Organization
Organization Name:OCONEE REHABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:ANDREWS
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:706-444-9200
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:GA
Mailing Address - Zip Code:31087
Mailing Address - Country:US
Mailing Address - Phone:706-444-9200
Mailing Address - Fax:706-444-9201
Practice Address - Street 1:446 SPRING STREET
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:GA
Practice Address - Zip Code:31087
Practice Address - Country:US
Practice Address - Phone:706-444-9200
Practice Address - Fax:706-444-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
116562OtherMEDICARE PROVIDER
GA000325212BMedicaid
GA116562Medicare ID - Type Unspecified