Provider Demographics
NPI:1124181201
Name:MASAND, GEETU J (OT)
Entity type:Individual
Prefix:
First Name:GEETU
Middle Name:J
Last Name:MASAND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 AUTUMN TRACE CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-8024
Mailing Address - Country:US
Mailing Address - Phone:478-745-9200
Mailing Address - Fax:478-745-9040
Practice Address - Street 1:2520 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-1571
Practice Address - Country:US
Practice Address - Phone:478-745-9200
Practice Address - Fax:478-745-9040
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist