Provider Demographics
NPI:1154546679
Name:DUSSEAU, JOANNA (OTRL)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:DUSSEAU
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 WILLOW BEND DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30028-4952
Mailing Address - Country:US
Mailing Address - Phone:404-694-8485
Mailing Address - Fax:
Practice Address - Street 1:2655 WILLOW BEND DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30028-4952
Practice Address - Country:US
Practice Address - Phone:404-694-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OT005663225XP0200X
GAOT005663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics