Provider Demographics
NPI:1508436411
Name:CELESTINE, KHYANDRIA DENAE (OT)
Entity Type:Individual
Prefix:
First Name:KHYANDRIA
Middle Name:DENAE
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6572 RIVER PARK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2214
Mailing Address - Country:US
Mailing Address - Phone:678-626-1833
Mailing Address - Fax:
Practice Address - Street 1:6572 RIVER PARK DR STE 101
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2214
Practice Address - Country:US
Practice Address - Phone:678-626-1833
Practice Address - Fax:678-626-1844
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist