Provider Demographics
NPI:1083782346
Name:YOUMANS, MARSHA T (MOT, OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:T
Last Name:YOUMANS
Suffix:
Gender:F
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4531 IDLEWOOD PARK
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6255
Mailing Address - Country:US
Mailing Address - Phone:404-307-9510
Mailing Address - Fax:770-808-5920
Practice Address - Street 1:4531 IDLEWOOD PARK
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6255
Practice Address - Country:US
Practice Address - Phone:404-307-9510
Practice Address - Fax:770-808-5920
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003960225XP0200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA380693OtherWELLCARE
GA733249790BMedicaid
GA733249790CMedicaid