MEDICARE: MRS. AMY SIEGEL 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	225XP0019X	Physical Rehabilitation Occupational Therapist	OT005640	GA
2	225XP0200X	Pediatric Occupational Therapist	OT005640	GA

General Provider Information

NPI Number	:	1154662914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY SIEGEL OTR/L

Provider Business Mailing Address
First Line	:	303 PARKWAY DR NE
Second Line	:	WELLNESS CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30312-1212
Country	:	US
Telephone Number	:	404-265-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 PARKWAY DRIVE NE
Second Line	:	WELLNESS CENTER
City	:	ATLANTA
State	:	GA
Zip	:	30312-5166
Country	:	US
Telephone Number	:	404-265-4000
Fax Number	:

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	06/14/2016

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