Provider Demographics
NPI:1265181200
Name:GOTTENBERG, JULIA S (COTA/L)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:S
Last Name:GOTTENBERG
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 ROSEDALE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4831
Mailing Address - Country:US
Mailing Address - Phone:770-906-8399
Mailing Address - Fax:
Practice Address - Street 1:4450 OLD HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-8813
Practice Address - Country:US
Practice Address - Phone:770-271-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002813224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant