Healthcare Provider Details

I. General information

NPI: 1619218989
Provider Name (Legal Business Name): CLAIRE SUTTON WHATLEY OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2013
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1389 WEBER INDUSTRIAL DR
CUMMING GA
30041
US

IV. Provider business mailing address

1389 WEBER INDUSTRIAL DR
CUMMING GA
30041
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number005633
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: