Provider Demographics
NPI:1043368616
Name:MARGOW, SHELLEY RACHELLE (OTDOTR/L)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:RACHELLE
Last Name:MARGOW
Suffix:
Gender:F
Credentials:OTDOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3050 ROYAL BLVD S STE 115
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4484
Mailing Address - Country:US
Mailing Address - Phone:770-310-4586
Mailing Address - Fax:770-754-9288
Practice Address - Street 1:11660 ALPHARETTA HWY
Practice Address - Street 2:SUITE 320
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4943
Practice Address - Country:US
Practice Address - Phone:770-754-0085
Practice Address - Fax:770-754-9715
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT001920225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000720717BMedicaid