Healthcare Provider Details

I. General information

NPI: 1043558786
Provider Name (Legal Business Name): REGINA SITTERLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 PEACHTREE DUNWOODY RD NE BDG 400 STE125
ATLANTA GA
30328-6773
US

IV. Provider business mailing address

5050 RODRICK TRL
MARIETTA GA
30066-3228
US

V. Phone/Fax

Practice location:
  • Phone: 678-587-9922
  • Fax: 866-587-9993
Mailing address:
  • Phone: 607-760-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT00562
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: