Provider Demographics
NPI:1518374792
Name:IVEY, FELICIA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:IVEY
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 WALLIS FARM WAY
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5462
Mailing Address - Country:US
Mailing Address - Phone:678-381-4130
Mailing Address - Fax:
Practice Address - Street 1:439 WALLIS FARM WAY
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5462
Practice Address - Country:US
Practice Address - Phone:678-381-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist