Provider Demographics
NPI:1437594629
Name:JAIN, SUBHASH C (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:SUBHASH
Middle Name:C
Last Name:JAIN
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:MR
Other - First Name:SUBHASH
Other - Middle Name:C
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:3750 TURNBURY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2402
Mailing Address - Country:US
Mailing Address - Phone:850-591-5070
Mailing Address - Fax:
Practice Address - Street 1:4385 JOHNS CREEK PKWY
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6093
Practice Address - Country:US
Practice Address - Phone:850-591-5070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002759225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist