Provider Demographics
NPI:1194907444
Name:RICH, JOETTA LYNN (OTR)
Entity type:Individual
Prefix:MRS
First Name:JOETTA
Middle Name:LYNN
Last Name:RICH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 COBB PKWY NW
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-8351
Mailing Address - Country:US
Mailing Address - Phone:770-974-1978
Mailing Address - Fax:
Practice Address - Street 1:3450 COBB PKWY NW
Practice Address - Street 2:SUITE 140
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-8351
Practice Address - Country:US
Practice Address - Phone:770-974-1978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-28
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004537225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist