Provider Demographics
NPI:1265471361
Name:STOREY, KATHLEEN G (OTR L)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:STOREY
Suffix:
Gender:F
Credentials:OTR L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 REDBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5647
Mailing Address - Country:US
Mailing Address - Phone:770-522-8900
Mailing Address - Fax:
Practice Address - Street 1:470 CLARA DR
Practice Address - Street 2:
Practice Address - City:WHITESBURG
Practice Address - State:GA
Practice Address - Zip Code:30185-2531
Practice Address - Country:US
Practice Address - Phone:770-214-0536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAA391144225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000841937CMedicaid