Healthcare Provider Details

I. General information

NPI: 1598439044
Provider Name (Legal Business Name): KIRSTIE ARLYN DAVANTES RIMANDO OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2021
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 OGLETHORPE AVE STE A2
ATHENS GA
30606-2221
US

IV. Provider business mailing address

2295 HENRY CLOWER BLVD STE 100
SNELLVILLE GA
30078-5707
US

V. Phone/Fax

Practice location:
  • Phone: 770-995-9600
  • Fax:
Mailing address:
  • Phone: 770-995-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT006339
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: