Provider Demographics
NPI:1386792539
Name:HARDMON, ANNETTE (OTRL)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:HARDMON
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:PO BOX 961553
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30296-6907
Mailing Address - Country:US
Mailing Address - Phone:404-630-0425
Mailing Address - Fax:770-716-8684
Practice Address - Street 1:130 TROLLING WAY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30215-5355
Practice Address - Country:US
Practice Address - Phone:404-630-0425
Practice Address - Fax:770-716-8684
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001039225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist