Provider Demographics
NPI:1689161143
Name:PERRY, MELANIE (OTR/L)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 SOFT WIND TER
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-8923
Mailing Address - Country:US
Mailing Address - Phone:678-906-3992
Mailing Address - Fax:
Practice Address - Street 1:22 BUFORD VILLAGE WAY STE 229
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8846
Practice Address - Country:US
Practice Address - Phone:678-482-6100
Practice Address - Fax:770-932-5684
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007033225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOT007033OtherSECRETARY OF STATE, STATE OF GEORGIA