Provider Demographics
NPI:1790084937
Name:ROBERTS, ONI TWANISHA (NCTMB, LNMT)
Entity Type:Individual
Prefix:
First Name:ONI
Middle Name:TWANISHA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:NCTMB, LNMT
Other - Prefix:
Other - First Name:TWANISHA
Other - Middle Name:ONI
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NCTMB, LNMT
Mailing Address - Street 1:160 CLAIREMONT AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2546
Mailing Address - Country:US
Mailing Address - Phone:404-348-0454
Mailing Address - Fax:404-518-6496
Practice Address - Street 1:160 CLAIREMONT AVE STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2546
Practice Address - Country:US
Practice Address - Phone:404-348-0454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT000896225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist