Healthcare Provider Details

I. General information

NPI: 1740314517
Provider Name (Legal Business Name): LEKESIAH NELSON MOSBY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KESIAH MOSBY OTR/L

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 SABLEWOOD DR
ALPHARETTA GA
30004-8048
US

IV. Provider business mailing address

385 SABLEWOOD DR
ALPHARETTA GA
30004-8048
US

V. Phone/Fax

Practice location:
  • Phone: 770-377-7628
  • Fax:
Mailing address:
  • Phone: 770-377-7628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License NumberOT004928
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberOT004928
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT004928
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT004928
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberOT004928
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: