Provider Demographics
NPI:1902846884
Name:MATHIS, FELICIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:MATHIS
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 1:537 COLD WATER LN
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-8066
Mailing Address - Country:US
Mailing Address - Phone:678-588-3789
Mailing Address - Fax:678-610-5604
Practice Address - Street 1:537 COLD WATER LN
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-8066
Practice Address - Country:US
Practice Address - Phone:678-588-3789
Practice Address - Fax:678-610-5604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00872583CMedicaid