MEDICARE: MR. JOSEPH P PICKAVANCE MS, OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT005474	GA

General Provider Information

NPI Number	:	1043575962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH P PICKAVANCE MS, OTR/L

Provider Business Mailing Address
First Line	:	1280 BROWNSTONE DRIVE
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30008-3251
Country	:	US
Telephone Number	:	404-232-0300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3193 HOWELL MILL RD NW
Second Line	:	STE 135
City	:	ATLANTA
State	:	GA
Zip	:	30327-2115
Country	:	US
Telephone Number	:	404-477-5746
Fax Number	:	404-477-5747

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	09/06/2012

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