Healthcare Provider Details

I. General information

NPI: 1215091186
Provider Name (Legal Business Name): PEDIATRIC OCCUPATIONAL THERAPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 ROSCOMMON N
MARTINEZ GA
30907-4741
US

IV. Provider business mailing address

3737 ROSCOMMON N
MARTINEZ GA
30907-4741
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-9996
  • Fax: 706-868-7497
Mailing address:
  • Phone: 706-860-9996
  • Fax: 706-868-7497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT001132
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT001132
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JANET W VINCENT
Title or Position: OWNER
Credential: OTRL
Phone: 706-860-9996