Healthcare Provider Details

I. General information

NPI: 1285278473
Provider Name (Legal Business Name): AVERY KATHERINE WHITE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 100
DULUTH GA
30096-5143
US

IV. Provider business mailing address

11800 AMBER PARK DR PKWY 400 BLDG 1, STE 200
ALPHARETTA GA
30009-2269
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-4228
  • Fax:
Mailing address:
  • Phone: 404-355-0743
  • Fax: 404-355-2136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT008853
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: