Provider Demographics
NPI:1366961765
Name:O'FARRELL, MARIA (OTR/L)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:O'FARRELL
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:KEELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:915 W PEACHTREE ST NW APT 627
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309
Mailing Address - Country:US
Mailing Address - Phone:404-431-8849
Mailing Address - Fax:
Practice Address - Street 1:495 WINN WAY STE 210
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1710
Practice Address - Country:US
Practice Address - Phone:770-209-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006820225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist