Provider Demographics
NPI:1265723043
Name:WASHINGTON, ISAAC III (OT)
Entity type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:WASHINGTON
Suffix:III
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6481
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30154-0025
Mailing Address - Country:US
Mailing Address - Phone:678-386-9561
Mailing Address - Fax:
Practice Address - Street 1:6520 SNOWBIRD LN
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5770
Practice Address - Country:US
Practice Address - Phone:678-386-9561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003857225X00000X
SC3445225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist