MEDICARE: MS. EMILY DANIELLE VENABLE MHS, 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	225X00000X	Occupational Therapist	OT004079	GA
2	225XE0001X	Environmental Modification Occupational Therapist	OT004079	GA
3	225XF0002X	Feeding, Eating & Swallowing Occupational Therapist	OT004079	GA
4	225XP0200X	Pediatric Occupational Therapist	OT004079	GA

General Provider Information

NPI Number	:	1578704391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMILY DANIELLE VENABLE MHS, OTR/L

Provider Business Mailing Address
First Line	:	4939 LOWER ROSWELL RD
Second Line	:	BLDG C, SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30068-4338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4939 LOWER ROSWELL RD
Second Line	:	BLDG C, SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30068-4338
Country	:	US
Telephone Number	:	770-578-1519
Fax Number	:	770-578-0860

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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