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General NPI Number Information
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NPI Number | 1851501464
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Entity Type | Individual
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Provider Name | JYOTIKA KOOVERJEE MISTRY OTR
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2296 TRAYWICK CHASE
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City | ALPHARETTA
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State | GA
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Zip | 30004-4219
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Country | US
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Telephone | 770-315-3049
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Fax | 678-366-1516
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Provider Business Mailing Address
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Address Line | 2296 TRAYWICK CHASE
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City | ALPHARETTA
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State | GA
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Zip | 30004-4219
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Country | US
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Telephone | 770-315-3049
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Fax | 678-366-1516
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | OT003437
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License Number State | GA
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