MEDICARE: ROBERT J. MCCLELLAN OT

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	OT003326	GA

General Provider Information

NPI Number	:	1588628259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J. MCCLELLAN OT

Provider Business Mailing Address
First Line	:	1700 CANTON HILLS CIR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-4612
Country	:	US
Telephone Number	:	770-633-7901
Fax Number	:	770-973-0263

Provider Business Practice Location Address
First Line	:	1700 CANTON HILLS CIR
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-4612
Country	:	US
Telephone Number	:	770-633-7901
Fax Number	:	770-973-0263

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	11/05/2010

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