Healthcare Provider Details

I. General information

NPI: 1225341894
Provider Name (Legal Business Name): NICOLE SARIT GOLANTE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11539 PARK WOODS CIR STE 502
ALPHARETTA GA
30005-2413
US

IV. Provider business mailing address

11539 PARK WOODS CIR STE 502
ALPHARETTA GA
30005-2413
US

V. Phone/Fax

Practice location:
  • Phone: 678-527-3224
  • Fax: 678-366-5886
Mailing address:
  • Phone: 678-527-3224
  • Fax: 678-366-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT003474
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: