Basic Information
| Provider Information | |||||||||
| NPI: | 1386185460 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | PORTEE | ||||||||
| FirstName: | SHARDAE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6250 RIVERVIEW RD SE APT 2116 | ||||||||
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| City: | SMYRNA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301262979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8033727151 | ||||||||
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| Practice Location | |||||||||
| Address1: | 966A KILLIAN HILL RD SW | ||||||||
| Address2: | |||||||||
| City: | LILBURN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300473102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709234815 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2017 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT006777 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand |
No ID Information.