Provider Demographics
NPI:1275877672
Name:DOCKERY, TASIA (MT-BC)
Entity Type:Individual
Prefix:
First Name:TASIA
Middle Name:
Last Name:DOCKERY
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1382 CHATLEY WAY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-5527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12010 ETRIS RD
Practice Address - Street 2:A-150
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1421
Practice Address - Country:US
Practice Address - Phone:678-223-3987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10500225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist