MEDICARE: CAROL NEMEROV OTR/L

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	225400000X	Rehabilitation Practitioner	OT004284	GA

General Provider Information

NPI Number	:	1558478503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL NEMEROV OTR/L

Provider Business Mailing Address
First Line	:	3347 RIVER HEIGHTS XING SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4861
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3347 RIVER HEIGHTS XING SE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30067-4861
Country	:	US
Telephone Number	:	770-980-9276
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. CAROL SPECTER NEMEROV
Credential	:	OTR/L
Telephone Number	:	770-980-9276

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	08/22/2020

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