Healthcare Provider Details

I. General information

NPI: 1639204050
Provider Name (Legal Business Name): JENNIFER FAITH HELLER OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 CLIFF VALLEY WAY NE STE 119
ATLANTA GA
30329-2435
US

IV. Provider business mailing address

1935 CLIFF VALLEY WAY NE STE 119
ATLANTA GA
30329-2435
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-5272
  • Fax: 404-636-5644
Mailing address:
  • Phone: 404-636-5272
  • Fax: 404-636-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number4936
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: