MEDICARE: OCCUPATIONAL THERAPY PLUS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT000204	GA

General Provider Information

NPI Number	:	1205999620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OCCUPATIONAL THERAPY PLUS, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1387
Second Line	:
City	:	EVANS
State	:	GA
Zip	:	30809-1387
Country	:	US
Telephone Number	:	706-863-7694
Fax Number	:

Provider Business Practice Location Address
First Line	:	4210 COLUMBIA RD
Second Line	:	BLDG. 12, SUITE C
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0401
Country	:	US
Telephone Number	:	706-863-7694
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. LANA M HARDEMAN
Credential	:	O.T.
Telephone Number	:	706-863-7694

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	08/22/2020

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