Healthcare Provider Details

I. General information

NPI: 1295836161
Provider Name (Legal Business Name): JUDY RENE' HAMBY MHS, OTR/L, BCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5380 ROSWELL RD NE
ATLANTA GA
30342-1916
US

IV. Provider business mailing address

803 COMMONS CT
WOODSTOCK GA
30189-3590
US

V. Phone/Fax

Practice location:
  • Phone: 404-250-1680
  • Fax:
Mailing address:
  • Phone: 678-494-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT000990
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: