Provider Demographics
NPI:1023173176
Name:MOLESKY, SUZANNE MARY (OTR)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MARY
Last Name:MOLESKY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5170 LOWER FAYETTEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2156
Mailing Address - Country:US
Mailing Address - Phone:770-252-3310
Mailing Address - Fax:770-254-9635
Practice Address - Street 1:5170 LOWER FAYETTEVILLE RD
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-2156
Practice Address - Country:US
Practice Address - Phone:770-252-3310
Practice Address - Fax:770-254-9635
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004006225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10047313OtherPROVIDER