Healthcare Provider Details

I. General information

NPI: 1164340956
Provider Name (Legal Business Name): LAUREN JORDAN THIEDE OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 GLENRIDGE DR STE 110
SANDY SPRINGS GA
30328-5572
US

IV. Provider business mailing address

6025 WHITEHALL RUN
SUWANEE GA
30024-3423
US

V. Phone/Fax

Practice location:
  • Phone: 404-247-7959
  • Fax: 404-393-2447
Mailing address:
  • Phone: 770-402-4406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT009906
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: