Provider Demographics
NPI:1396128005
Name:LEDFORD, TWANNA
Entity type:Individual
Prefix:
First Name:TWANNA
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GAINES SCHOOL RD
Mailing Address - Street 2:APT G61
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3192
Mailing Address - Country:US
Mailing Address - Phone:636-698-4825
Mailing Address - Fax:
Practice Address - Street 1:750 GAINES SCHOOL RD
Practice Address - Street 2:APT G61
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3192
Practice Address - Country:US
Practice Address - Phone:636-698-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001912224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOTA001912OtherCOTA GA LICENCE NUMBER