Healthcare Provider Details

I. General information

NPI: 1093431496
Provider Name (Legal Business Name): MARY LEIGH AMEREIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 BRIARWOOD INDUSTRIAL CT NE STE A
BROOKHAVEN GA
30329-1642
US

IV. Provider business mailing address

4593 LASALLE CT
MARIETTA GA
30062-6497
US

V. Phone/Fax

Practice location:
  • Phone: 404-636-5272
  • Fax:
Mailing address:
  • Phone: 770-861-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: