Healthcare Provider Details

I. General information

NPI: 1851699243
Provider Name (Legal Business Name): JESSICA LAURETTE SIBLEY M.S. OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 03/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1430 SHERIDAN WALK NE
ATLANTA GA
30324-3255
US

V. Phone/Fax

Practice location:
  • Phone: 404-234-4719
  • Fax:
Mailing address:
  • Phone: 404-234-4719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT005223
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: