Provider Demographics
NPI:1518987809
Name:MONROE, PATRICIA C (OTL, CHT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:C
Last Name:MONROE
Suffix:
Gender:F
Credentials:OTL, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 CANTERBURY DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-3101
Mailing Address - Country:US
Mailing Address - Phone:706-202-1055
Mailing Address - Fax:
Practice Address - Street 1:119 CANTERBURY DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-3101
Practice Address - Country:US
Practice Address - Phone:706-202-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000600225X00000X, 225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I670055Medicare PIN
GA67BBBKRMedicare ID - Type Unspecified