MEDICARE: JEAN MARKLEY SEVER MSOTRL

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	225XP0200X	Pediatric Occupational Therapist	OT002505	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	985589	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1497810295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN MARKLEY SEVER MSOTRL

Provider Business Mailing Address
First Line	:	3876 MENLO DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-5116
Country	:	US
Telephone Number	:	770-842-6328
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 HOLCOMB WOODS PKWY
Second Line	:	STE426
City	:	ROSWELL
State	:	GA
Zip	:	30076-2575
Country	:	US
Telephone Number	:	770-851-9553
Fax Number	:	770-698-4178

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	07/08/2007

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Directions to “ JEAN MARKLEY SEVER MSOTRL” Practice Location

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