Healthcare Provider Details

I. General information

NPI: 1780758110
Provider Name (Legal Business Name): HEIDI LOBEL MARTIN MS OTRL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 COLEWOOD CT NW STE 426
ATLANTA GA
30328-2921
US

IV. Provider business mailing address

6420 COLEWOOD CT NW
ATLANTA GA
30328-2921
US

V. Phone/Fax

Practice location:
  • Phone: 770-654-9542
  • Fax: 404-255-9239
Mailing address:
  • Phone: 770-654-9542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT003007
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: