Provider Demographics
NPI:1588742464
Name:MAGUIRE, VERONICA A (OTR)
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:A
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2258 WRIGHTSBORO ROAD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-724-6543
Mailing Address - Fax:206-350-9023
Practice Address - Street 1:2258 WRIGHTSBORO ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-724-6543
Practice Address - Fax:206-350-9023
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000285225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10065244OtherAMERIGROUP ID
GA000581567BMedicaid
GA312248OtherWELLCARE PROVIDER #