Healthcare Provider Details

I. General information

NPI: 1982727434
Provider Name (Legal Business Name): SUSANNE ELISE PICKERING OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 CLIFTON RD NE
ATLANTA GA
30329-4021
US

IV. Provider business mailing address

1449 OAKRIDGE CIR
DECATUR GA
30033-2133
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-4585
  • Fax: 404-728-4931
Mailing address:
  • Phone: 404-274-4581
  • Fax: 404-639-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number002734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: