Healthcare Provider Details

I. General information

NPI: 1902223563
Provider Name (Legal Business Name): STEPHANIE SANDHERR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 OLD ORCHARD CT
MARIETTA GA
30068-3440
US

IV. Provider business mailing address

330 OLD ORCHARD CT
MARIETTA GA
30068-3440
US

V. Phone/Fax

Practice location:
  • Phone: 832-443-6433
  • Fax:
Mailing address:
  • Phone: 832-443-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT005347
License Number StateGA

VIII. Authorized Official

Name: STEPHANIE SANDHERR
Title or Position: OCCUPATIONAL THERAPIST/OWNER
Credential:
Phone: 832-443-6433