Provider Demographics
NPI:1699836502
Name:DEVORE, BRETT R (MS, OTRL)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:R
Last Name:DEVORE
Suffix:
Gender:M
Credentials:MS, OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11539 PARK WOODS CIR
Mailing Address - Street 2:SUITE 502
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4413
Mailing Address - Country:US
Mailing Address - Phone:678-527-3224
Mailing Address - Fax:
Practice Address - Street 1:11539 PARK WOODS CIR
Practice Address - Street 2:SUITE 502
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4413
Practice Address - Country:US
Practice Address - Phone:678-527-3224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002774225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics