Provider Demographics
NPI:1053522391
Name:JUMPSTART THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:JUMPSTART THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:STENSAAS
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:404-550-9476
Mailing Address - Street 1:300 BAINBRIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4271
Mailing Address - Country:US
Mailing Address - Phone:404-550-9476
Mailing Address - Fax:
Practice Address - Street 1:300 BAINBRIDGE DR NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4271
Practice Address - Country:US
Practice Address - Phone:404-550-9476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003970225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52152600OtherBLUECROSS BLUE SHIELD
GA52152600OtherBLUECROSS BLUE SHIELD