Provider Demographics
NPI:1679518690
Name:FARTHING, DAVID LEE (OT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LEE
Last Name:FARTHING
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410 DEKALB MEDICAL PARKWAY
Mailing Address - Street 2:SUITE E
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058
Mailing Address - Country:US
Mailing Address - Phone:678-418-8072
Mailing Address - Fax:578-518-0137
Practice Address - Street 1:2410 DEKALB MEDICAL PARKWAY
Practice Address - Street 2:SUITE E
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:678-418-8072
Practice Address - Fax:578-518-0137
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002339225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist