Provider Demographics
NPI:1134317035
Name:CARLTON, RETHA MAE (MPH OTR/L CHT)
Entity Type:Individual
Prefix:MRS
First Name:RETHA
Middle Name:MAE
Last Name:CARLTON
Suffix:
Gender:F
Credentials:MPH OTR/L CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1230
Mailing Address - Country:US
Mailing Address - Phone:770-682-6225
Mailing Address - Fax:
Practice Address - Street 1:920 RIVER CENTRE PL
Practice Address - Street 2:SUITE 200
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-7320
Practice Address - Country:US
Practice Address - Phone:770-682-6225
Practice Address - Fax:770-682-6275
Is Sole Proprietor?:No
Enumeration Date:2007-10-05
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT 003690225X00000X
GAOT003690225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA9611000449OtherHAND THERAPY CERTIFICATE