Provider Demographics
NPI:1972566958
Name:ABBOTT, RHONDA (OT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:ABBOTT
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:K
Other - Last Name:SWENA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1505 STONE BRIDGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8282
Mailing Address - Country:US
Mailing Address - Phone:770-926-9112
Mailing Address - Fax:770-926-4259
Practice Address - Street 1:1505 STONE BRIDGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-926-9112
Practice Address - Fax:770-926-4259
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ31752Medicare UPIN
GA67BBBLQMedicare ID - Type Unspecified