Provider Demographics
NPI:1689818544
Name:JAYA, HATINAWEDU TINA (OTR/L,MPH,CHT)
Entity Type:Individual
Prefix:MS
First Name:HATINAWEDU
Middle Name:TINA
Last Name:JAYA
Suffix:
Gender:F
Credentials:OTR/L,MPH,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3968 FELTON HILL RD SW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-3506
Mailing Address - Country:US
Mailing Address - Phone:678-214-6960
Mailing Address - Fax:678-214-6961
Practice Address - Street 1:3968 FELTON HILL RD SW
Practice Address - Street 2:SUITE 220
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-3506
Practice Address - Country:US
Practice Address - Phone:678-214-6960
Practice Address - Fax:678-214-6961
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002372225X00000X
GA1021100256225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand