Provider Demographics
NPI:1962154179
Name:TRUE, AVA (OT)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:
Last Name:TRUE
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:
Other - Last Name:ZEAGLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OT
Mailing Address - Street 1:PO BOX 1220
Mailing Address - Street 2:
Mailing Address - City:RINCON
Mailing Address - State:GA
Mailing Address - Zip Code:31326-1220
Mailing Address - Country:US
Mailing Address - Phone:912-667-6468
Mailing Address - Fax:912-324-4241
Practice Address - Street 1:5723 GA HIGHWAY 21 S
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5554
Practice Address - Country:US
Practice Address - Phone:912-667-6468
Practice Address - Fax:912-324-4241
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist