Provider Demographics
NPI:1679645634
Name:STRICKLAND, MARIE PACKARD
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:PACKARD
Last Name:STRICKLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:EVELYN
Other - Last Name:PACKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6220 BENBROOKE DR NW
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8488
Mailing Address - Country:US
Mailing Address - Phone:770-429-0080
Mailing Address - Fax:770-434-3999
Practice Address - Street 1:116 FORREST AVE
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3640
Practice Address - Country:US
Practice Address - Phone:770-382-3206
Practice Address - Fax:770-382-3276
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002950225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA312663OtherWELLCARE
GA10035986OtherAMERIGROUP
GA52806450 003OtherBLUE CROSS BLUE SHIELD
GA52806450 002OtherBLUE CROSS BLUE SHIELD
GA52806450 004OtherBLUE CROSS BLUE SHIELD