Healthcare Provider Details

I. General information

NPI: 1962029256
Provider Name (Legal Business Name): EMILY ECKEMOFF MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

3220 DUNDEE RIDGE WAY
DULUTH GA
30096-6639
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 336-380-6278
  • Fax: 678-250-9010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007689
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: