Provider Demographics
NPI:1992937007
Name:FLECKENSTEIN, JOANN MARIE CORDERO (MS, OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:MARIE CORDERO
Last Name:FLECKENSTEIN
Suffix:
Gender:
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:AVONDALE ESTATES
Mailing Address - State:GA
Mailing Address - Zip Code:30002-1048
Mailing Address - Country:US
Mailing Address - Phone:919-610-5737
Mailing Address - Fax:
Practice Address - Street 1:140 LOCUST ST
Practice Address - Street 2:
Practice Address - City:AVONDALE ESTATES
Practice Address - State:GA
Practice Address - Zip Code:30002-1048
Practice Address - Country:US
Practice Address - Phone:404-754-5368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005996225X00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist