Provider Demographics
NPI:1992061055
Name:WOODS, JEANETTE LONG (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:LONG
Last Name:WOODS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8028 GLEN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31820-4346
Mailing Address - Country:US
Mailing Address - Phone:706-565-6553
Mailing Address - Fax:706-565-6553
Practice Address - Street 1:3645 GENTIAN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-5687
Practice Address - Country:US
Practice Address - Phone:706-507-4433
Practice Address - Fax:706-507-4463
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002504225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist