Provider Demographics
NPI:1316647316
Name:ENNIS, TEMPERANCE MILLER (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:TEMPERANCE
Middle Name:MILLER
Last Name:ENNIS
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 CUMBERLAND BLVD SE UNIT 530
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4393
Mailing Address - Country:US
Mailing Address - Phone:205-499-3416
Mailing Address - Fax:
Practice Address - Street 1:1230 JOHNSON FERRY PL STE G10
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2045
Practice Address - Country:US
Practice Address - Phone:770-321-6705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008767225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist