Provider Demographics
NPI:1063718286
Name:SLAUGHTER, SEAN CHARLES (OTR/L)
Entity type:Individual
Prefix:MR
First Name:SEAN
Middle Name:CHARLES
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRADLEY PARK CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3638
Mailing Address - Country:US
Mailing Address - Phone:706-221-0112
Mailing Address - Fax:706-221-0114
Practice Address - Street 1:4 BRADLEY PARK CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3638
Practice Address - Country:US
Practice Address - Phone:706-221-0112
Practice Address - Fax:706-221-0114
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002478225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics