Healthcare Provider Details

I. General information

NPI: 1447680434
Provider Name (Legal Business Name): NAEHA PATEL SUR MS, OTR/L, CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2013
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1772 MOUNTAIN OAK RD NW
KENNESAW GA
30152-4278
US

IV. Provider business mailing address

1772 MOUNTAIN OAK RD NW
KENNESAW GA
30152-4278
US

V. Phone/Fax

Practice location:
  • Phone: 678-498-0588
  • Fax:
Mailing address:
  • Phone: 678-498-0588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT005797
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number358932
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: