Provider Demographics
NPI:1437429156
Name:KEARNEY, MICHAELENE SAGE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MICHAELENE
Middle Name:SAGE
Last Name:KEARNEY
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 1:5655 PEACHTREE PKWY
Mailing Address - Street 2:SUITE 117
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-2812
Mailing Address - Country:US
Mailing Address - Phone:770-798-9844
Mailing Address - Fax:770-798-9832
Practice Address - Street 1:5635 PEACHTREE PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-2879
Practice Address - Country:US
Practice Address - Phone:770-798-9844
Practice Address - Fax:770-798-9832
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000954174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist