Provider Demographics
NPI:1063641959
Name:JUSTIN, SHEBA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHEBA
Middle Name:
Last Name:JUSTIN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2320
Mailing Address - Country:US
Mailing Address - Phone:770-831-2313
Mailing Address - Fax:770-831-2778
Practice Address - Street 1:1000 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2114
Practice Address - Country:US
Practice Address - Phone:770-831-2313
Practice Address - Fax:770-831-2778
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004909225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist