MEDICARE: MARIA O'FARRELL 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	OT006820	GA

General Provider Information

NPI Number	:	1366961765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA O'FARRELL OTR/L

Provider Business Mailing Address
First Line	:	915 W PEACHTREE ST NW APT 627
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309
Country	:	US
Telephone Number	:	404-431-8849
Fax Number	:

Provider Business Practice Location Address
First Line	:	495 WINN WAY STE 210
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30030-1710
Country	:	US
Telephone Number	:	770-209-9826
Fax Number	:

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	01/24/2019

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