Provider Demographics
NPI:1427245828
Name:AUSTIN, LASHAY M (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:LASHAY
Middle Name:M
Last Name:AUSTIN
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:PO BOX 2128
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-7509
Mailing Address - Country:US
Mailing Address - Phone:843-319-0592
Mailing Address - Fax:404-346-7869
Practice Address - Street 1:2790 ELKMONT RDG SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9434
Practice Address - Country:US
Practice Address - Phone:843-319-0592
Practice Address - Fax:404-346-7869
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-29
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004360225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1427245828Medicaid