Provider Demographics
NPI:1093431496
Name:AMEREIN, MARY LEIGH
Entity Type:Individual
Prefix:
First Name:MARY LEIGH
Middle Name:
Last Name:AMEREIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4593 LASALLE CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6497
Mailing Address - Country:US
Mailing Address - Phone:770-861-2363
Mailing Address - Fax:
Practice Address - Street 1:1816 BRIARWOOD INDUSTRIAL CT NE STE A
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1642
Practice Address - Country:US
Practice Address - Phone:404-636-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics