Provider Demographics
NPI:1043575962
Name:PICKAVANCE, JOSEPH P (MS, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:P
Last Name:PICKAVANCE
Suffix:
Gender:M
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 BROWNSTONE DRIVE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30008-3251
Mailing Address - Country:US
Mailing Address - Phone:404-232-0300
Mailing Address - Fax:
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:STE 135
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2115
Practice Address - Country:US
Practice Address - Phone:404-477-5746
Practice Address - Fax:404-477-5747
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005474225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist