Provider Demographics
NPI:1821806431
Name:PETERS, ROSEMARY ELLEN (OTD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:ELLEN
Last Name:PETERS
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 BOLD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-2744
Mailing Address - Country:US
Mailing Address - Phone:770-267-9357
Mailing Address - Fax:
Practice Address - Street 1:2385 LAWRENCEVILLE HWY STE A
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3168
Practice Address - Country:US
Practice Address - Phone:404-289-4270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-28
Last Update Date:2024-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009395225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist