Provider Demographics
NPI:1417018391
Name:PAYNE, MARGARET THERESE (OTR/L,SIPT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:THERESE
Last Name:PAYNE
Suffix:
Gender:F
Credentials:OTR/L,SIPT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:THERESE
Other - Last Name:VANBUREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L,SIPT
Mailing Address - Street 1:409 ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-3228
Mailing Address - Country:US
Mailing Address - Phone:770-965-1861
Mailing Address - Fax:678-866-6076
Practice Address - Street 1:409 ZION CHURCH RD
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3228
Practice Address - Country:US
Practice Address - Phone:770-965-1861
Practice Address - Fax:678-866-6076
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004005225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA718143118AMedicaid