Healthcare Provider Details

I. General information

NPI: 1558674101
Provider Name (Legal Business Name): CAROLYN MOSHIER TURNER OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ATLANTA HWY
CUMMING GA
30040-8099
US

IV. Provider business mailing address

4960 CRIPPLE CREEK CT
CUMMING GA
30040-6444
US

V. Phone/Fax

Practice location:
  • Phone: 770-886-6204
  • Fax:
Mailing address:
  • Phone: 770-312-6905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT003719
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: