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General NPI Number Information
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NPI Number | 1558047290
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Entity Type | Individual
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Provider Name | SHEMONICA KEANNE ROBERTS
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Gender | Female
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 2280 HIGHWAY 29 N
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City | NEWNAN
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State | GA
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Zip | 30265-1031
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Country | US
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Telephone | 770-683-6904
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Fax |
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Provider Business Mailing Address
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Address Line | 280 BEVERLY PARK CT
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City | NEWNAN
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State | GA
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Zip | 30263-6028
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Country | US
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Telephone | 770-253-1835
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Fax |
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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 | 224ZF0002X
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Taxonomy Name | Feeding, Eating & Swallowing Occupational Therapy Assistant
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License Number | OTA002108
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License Number State | GA
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