Provider Demographics
NPI:1821714403
Name:MORONE, KASEY ALEXANDRA (OT)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:ALEXANDRA
Last Name:MORONE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28528
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30358-0528
Mailing Address - Country:US
Mailing Address - Phone:404-247-7995
Mailing Address - Fax:404-393-2447
Practice Address - Street 1:5585 GLENRIDGE DR STE 110
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1335
Practice Address - Country:US
Practice Address - Phone:404-247-7959
Practice Address - Fax:404-393-2447
Is Sole Proprietor?:No
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008667225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist