Healthcare Provider Details

I. General information

NPI: 1154827509
Provider Name (Legal Business Name): REBECCA ANN GELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 CHURCH ST NE STE 104
MARIETTA GA
30060-7291
US

IV. Provider business mailing address

3968 FELTON HILL RD SW STE 100
SMYRNA GA
30082-3522
US

V. Phone/Fax

Practice location:
  • Phone: 770-333-7888
  • Fax: 770-333-7889
Mailing address:
  • Phone: 770-333-7888
  • Fax: 770-333-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT006958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: