Provider Demographics
NPI:1528563962
Name:HARTLEY, CYNTHIA MARIE (OT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:MARIE
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:135 CHANSON CT
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7308
Mailing Address - Country:US
Mailing Address - Phone:404-242-7184
Mailing Address - Fax:
Practice Address - Street 1:400 MARIETTA HWY
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4706
Practice Address - Country:US
Practice Address - Phone:770-650-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000733225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist