MEDICARE: NELL P DEVORE MS, OTRL

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	225XP0200X	Pediatric Occupational Therapist	OT002409	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881759769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELL P DEVORE MS, OTRL

Provider Business Mailing Address
First Line	:	5871 GLENRIDGE DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5304
Country	:	US
Telephone Number	:	770-415-9165
Fax Number	:	678-280-2416

Provider Business Practice Location Address
First Line	:	5871 GLENRIDGE DR STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30328-5304
Country	:	US
Telephone Number	:	770-415-9165
Fax Number	:	678-280-2416

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	10/23/2022

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