Provider Demographics
NPI:1265892640
Name:BEASLEY, JIMMIE MICHELLE (OTR/L)
Entity type:Individual
Prefix:
First Name:JIMMIE
Middle Name:MICHELLE
Last Name:BEASLEY
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 1:2450 ATLANTA HWY
Mailing Address - Street 2:STE1001
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-1224
Mailing Address - Country:US
Mailing Address - Phone:404-834-8404
Mailing Address - Fax:678-807-5733
Practice Address - Street 1:2450 ATLANTA HWY STE 1001
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1252
Practice Address - Country:US
Practice Address - Phone:404-834-8404
Practice Address - Fax:678-807-5733
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006335225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist