Provider Demographics
NPI:1649576398
Name:HARVEY, KEVIN JEROME (MOT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:JEROME
Last Name:HARVEY
Suffix:
Gender:M
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9540 FERNANDINA DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2069
Mailing Address - Country:US
Mailing Address - Phone:404-290-8825
Mailing Address - Fax:678-715-6221
Practice Address - Street 1:9540 FERNANDINA DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-2069
Practice Address - Country:US
Practice Address - Phone:404-290-8825
Practice Address - Fax:678-715-6221
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004319225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist