Healthcare Provider Details

I. General information

NPI: 1558478503
Provider Name (Legal Business Name): CAROL NEMEROV OTR/L
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3347 RIVER HEIGHTS XING SE
MARIETTA GA
30067-4861
US

IV. Provider business mailing address

3347 RIVER HEIGHTS XING SE
MARIETTA GA
30067-4861
US

V. Phone/Fax

Practice location:
  • Phone: 770-980-9276
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberOT004284
License Number StateGA

VIII. Authorized Official

Name: MS. CAROL SPECTER NEMEROV
Title or Position: OWNER
Credential: OTR/L
Phone: 770-980-9276