Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT002308 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT002308 | GA |
NPI | 1003930454 |
---|---|
Provider Name | Michelle Marie Marchese-Deutscher |
First Address | Fayetteville, GA 30215 |
Second Address | Fayetteville, GA 30215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 08/07/2007 |