Provider Demographics
NPI:1619059888
Name:MINCEY, MARETTA GEORGETTA (MS)
Entity Type:Individual
Prefix:
First Name:MARETTA
Middle Name:GEORGETTA
Last Name:MINCEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 385
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-0385
Mailing Address - Country:US
Mailing Address - Phone:770-896-6518
Mailing Address - Fax:678-567-1926
Practice Address - Street 1:2735 LOST LAKES DRIVE
Practice Address - Street 2:
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127
Practice Address - Country:US
Practice Address - Phone:770-896-6518
Practice Address - Fax:678-567-1926
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist