=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780986612
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTY ABERNATHY MCDONALD OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2010
-----------------------------------------------------
Last Update Date | 09/07/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 575 OLD ALABAMA RD.
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-729-5571
-----------------------------------------------------
Fax | 770-386-0868
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 OLD ALABAMA RD.
-----------------------------------------------------
City | CARTERSVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-729-5571
-----------------------------------------------------
Fax | 770-386-0868
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | OT003793
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------