Provider Demographics
NPI:1508526401
Name:HARISHCHANDRA, JAYNA (OTR)
Entity Type:Individual
Prefix:
First Name:JAYNA
Middle Name:
Last Name:HARISHCHANDRA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 BOBWHITE TRL
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-5886
Mailing Address - Country:US
Mailing Address - Phone:706-726-7745
Mailing Address - Fax:
Practice Address - Street 1:536 GRAND SLAM DR STE D
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-8045
Practice Address - Country:US
Practice Address - Phone:706-854-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008317225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics