Provider Demographics
NPI:1740809490
Name:O'CONNOR, KERRI (MOT)
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 DUE WEST RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2125
Mailing Address - Country:US
Mailing Address - Phone:770-443-9672
Mailing Address - Fax:
Practice Address - Street 1:3044 DUE WEST RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-2125
Practice Address - Country:US
Practice Address - Phone:770-443-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007711225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist