Healthcare Provider Details

I. General information

NPI: 1922594928
Provider Name (Legal Business Name): PAULA MARIE NAGORSKI OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 07/03/2018
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

5405 TALLANTWORTH XING
CUMMING GA
30040-5290
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-7676
  • Fax: 770-615-0177
Mailing address:
  • Phone: 404-916-0935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007042
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: