Healthcare Provider Details

I. General information

NPI: 1548746506
Provider Name (Legal Business Name): RUTH ANN STREET MS, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2018
Last Update Date: 07/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRING ST SE STE 101
GAINESVILLE GA
30501-3773
US

IV. Provider business mailing address

1035 SCALES RD APT 5207
SUWANEE GA
30024-4591
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-0177
  • Fax:
Mailing address:
  • Phone: 630-877-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007080
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: