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General NPI Number Information
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NPI Number | 1043452212
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Entity Type | Individual
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Provider Name | THERESA DONDZILA OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 1510 OAK GROVE RD STE. 2
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City | DECATUR
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State | GA
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Zip | 30033-2701
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Country | US
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Telephone | 404-236-9788
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Fax |
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Provider Business Mailing Address
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Address Line | 2385 HEATHER DRIVE
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City | DECATUR
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State | GA
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Zip | 30033-2701
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Country | US
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Telephone | 404-966-0276
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Fax | 678-301-4226
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 2413
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License Number State | GA
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