Provider Demographics
NPI:1235397837
Name:RICKS, NORMANIE MCKENZIE (OTR)
Entity Type:Individual
Prefix:
First Name:NORMANIE
Middle Name:MCKENZIE
Last Name:RICKS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:NORMANIE
Other - Middle Name:MCKENZIE
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2265 ROSWELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-2980
Mailing Address - Country:US
Mailing Address - Phone:770-509-2232
Mailing Address - Fax:
Practice Address - Street 1:2265 ROSWELL RD STE 100
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062
Practice Address - Country:US
Practice Address - Phone:770-509-2232
Practice Address - Fax:770-509-2233
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004714225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist