Provider Demographics
NPI:1235202086
Name:JORDAN, HELENA (OTRL)
Entity Type:Individual
Prefix:
First Name:HELENA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 IVY ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7238
Mailing Address - Country:US
Mailing Address - Phone:770-912-5162
Mailing Address - Fax:678-352-9907
Practice Address - Street 1:995 IVY ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7238
Practice Address - Country:US
Practice Address - Phone:770-912-5162
Practice Address - Fax:678-352-9907
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003698225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics