Provider Demographics
NPI:1245919646
Name:IRVIN, ZOE MADISON (OTR/L)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:MADISON
Last Name:IRVIN
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 1:601 GLENWOOD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-6623
Mailing Address - Country:US
Mailing Address - Phone:404-938-5736
Mailing Address - Fax:
Practice Address - Street 1:601 GLENWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6623
Practice Address - Country:US
Practice Address - Phone:404-938-5736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008897225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist