Basic Information
| Provider Information | |||||||||
| NPI: | 1528563962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTLEY | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | OT | ||||||||
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| OtherLastName: | HARTLEY | ||||||||
| OtherFirstName: | CINDY | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 135 CHANSON CT | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300757308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042427184 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 400 MARIETTA HWY | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300754706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7706500555 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 03/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 000733 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.