Provider Demographics
NPI:1598969826
Name:MASON, SHEILA VERNICE (OTRL)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:VERNICE
Last Name:MASON
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 WILLOW WAY DR
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3856
Mailing Address - Country:US
Mailing Address - Phone:770-323-7797
Mailing Address - Fax:
Practice Address - Street 1:2521 WILLOW WAY DR
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3856
Practice Address - Country:US
Practice Address - Phone:770-323-7797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000657225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist