Provider Demographics
NPI:1265304125
Name:THE OT TABLE, LLC
Entity type:Organization
Organization Name:THE OT TABLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:770-560-4431
Mailing Address - Street 1:803 RICHARDS RD NE
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:GA
Mailing Address - Zip Code:30184-2102
Mailing Address - Country:US
Mailing Address - Phone:770-560-4431
Mailing Address - Fax:
Practice Address - Street 1:803 RICHARDS RD NE
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:GA
Practice Address - Zip Code:30184-2102
Practice Address - Country:US
Practice Address - Phone:770-560-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-20
Last Update Date:2025-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty