MEDICARE: MRS. SUSAN H. KRONENBERGER 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	OT000938	GA
2	225XP0200X	Pediatric Occupational Therapist	OT000938	GU

General Provider Information

NPI Number	:	1821238627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SUSAN H. KRONENBERGER OTR/L

Provider Business Mailing Address
First Line	:	4939 LOWER ROSWELL RD
Second Line	:	BUILDING C, SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30068-4338
Country	:	US
Telephone Number	:	770-578-0860
Fax Number	:	770-578-1519

Provider Business Practice Location Address
First Line	:	4939 LOWER ROSWELL RD
Second Line	:	BUILDING C, SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30068-4338
Country	:	US
Telephone Number	:	770-578-0860
Fax Number	:	770-578-1519

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

Provider Enumeration Date	:	03/06/2009
Last Update Date	:	03/06/2009

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