Provider Demographics
NPI:1073048666
Name:MARBACH, PEGGY (OTD, OTR)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:
Last Name:MARBACH
Suffix:
Gender:F
Credentials:OTD, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6849 PEACHTREE DUNWOODY RD BLDG B4
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-6776
Mailing Address - Country:US
Mailing Address - Phone:770-522-9800
Mailing Address - Fax:678-786-9845
Practice Address - Street 1:6849 PEACHTREE DUNWOODY RD BLDG B4
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:770-522-9800
Practice Address - Fax:678-786-9845
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
GA000406225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1437689288OtherORGANIZATIONAL NPI