Healthcare Provider Details

I. General information

NPI: 1578073284
Provider Name (Legal Business Name): ELIZABETH GAMA OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2017
Last Update Date: 08/18/2024
Certification Date: 08/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 PEA RIDGE RD
GAINESVILLE GA
30506-6120
US

IV. Provider business mailing address

6850 PEA RIDGE RD
GAINESVILLE GA
30506-6120
US

V. Phone/Fax

Practice location:
  • Phone: 678-989-8717
  • Fax:
Mailing address:
  • Phone: 678-989-8717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT5530
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: