Provider Demographics
NPI:1831467562
Name:WHITFIELD, DAMALI ABENAA (OTR/L)
Entity Type:Individual
Prefix:
First Name:DAMALI
Middle Name:ABENAA
Last Name:WHITFIELD
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 1:1138 LANIER SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7271
Mailing Address - Country:US
Mailing Address - Phone:718-772-7199
Mailing Address - Fax:770-904-6418
Practice Address - Street 1:4992 BRISTOL INDUSTRIAL WAY
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-1742
Practice Address - Country:US
Practice Address - Phone:770-904-6419
Practice Address - Fax:770-904-6418
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2019-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005355225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics