Provider Demographics
NPI:1801337126
Name:RICKS, SIEDAH (COTA/L)
Entity type:Individual
Prefix:
First Name:SIEDAH
Middle Name:
Last Name:RICKS
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 1:139 CLAXTON HEIGHTS CIR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2472
Mailing Address - Country:US
Mailing Address - Phone:478-697-8256
Mailing Address - Fax:
Practice Address - Street 1:139 CLAXTON HEIGHTS CIR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2472
Practice Address - Country:US
Practice Address - Phone:478-697-8256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001985224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant