Provider Demographics
NPI:1841913381
Name:MACIE, DONNA LEIGH (OCCUPATIONAL THERAPI)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LEIGH
Last Name:MACIE
Suffix:
Gender:F
Credentials:OCCUPATIONAL THERAPI
Other - Prefix:MRS
Other - First Name:DONNA
Other - Middle Name:LEIGH
Other - Last Name:SNOW MACIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1515 JOHNSON FERRY RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-6492
Mailing Address - Country:US
Mailing Address - Phone:770-977-9457
Mailing Address - Fax:
Practice Address - Street 1:1515 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-6492
Practice Address - Country:US
Practice Address - Phone:770-977-9457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002673225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA58-1940036Medicaid