Provider Demographics
NPI:1386812899
Name:BIRMINGHAM, BETH MARGARET (OTR/L, CHT)
Entity type:Individual
Prefix:MS
First Name:BETH
Middle Name:MARGARET
Last Name:BIRMINGHAM
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:MS
Other - First Name:LISABETH
Other - Middle Name:M
Other - Last Name:BIRMINGHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L, CHT
Mailing Address - Street 1:4755 RIVERSOUND DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-8562
Mailing Address - Country:US
Mailing Address - Phone:770-310-6497
Mailing Address - Fax:
Practice Address - Street 1:575 DEKALB INDUSTRIAL WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1756
Practice Address - Country:US
Practice Address - Phone:404-296-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002737225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist