Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 000406 | GA |
NPI | 1073048666 |
---|---|
Provider Name | Dr. Peggy Marbach |
First Address | Sandy Springs, GA 30328-6776 |
Second Address | Sandy Springs, GA 30328 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2017 |
Last Update Date | 11/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1437689288 | ORGANIZATIONAL NPI (01) | GA |