Provider Demographics
NPI:1699715987
Name:WOSKE, ADRIENNE (OT)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:WOSKE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2407 ANDOVER DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1280
Mailing Address - Country:US
Mailing Address - Phone:229-247-0038
Mailing Address - Fax:229-671-1005
Practice Address - Street 1:2407 ANDOVER DR
Practice Address - Street 2:SUITE B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1280
Practice Address - Country:US
Practice Address - Phone:229-247-0038
Practice Address - Fax:229-671-1005
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2492225X00000X
GAOT004574225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890017520Medicaid
AL51537177Medicaid
AL890017520Medicaid