Provider Demographics
NPI:1649223587
Name:MORENO, SEEMA (OTR/L)
Entity Type:Individual
Prefix:
First Name:SEEMA
Middle Name:
Last Name:MORENO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:SEEMA
Other - Middle Name:
Other - Last Name:SUMMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:375 MCDONOUGH RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:GA
Mailing Address - Zip Code:30233-1509
Mailing Address - Country:US
Mailing Address - Phone:770-775-4622
Mailing Address - Fax:770-775-4132
Practice Address - Street 1:375 MCDONOUGH RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1509
Practice Address - Country:US
Practice Address - Phone:770-775-4622
Practice Address - Fax:770-775-4132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002221225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist