Organization
PEDIATRIC OCCUPATIONAL THERAPY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANET W VINCENT OTRL (OWNER)
(706) 860-9996
Entity
Organization
Contact information
Practice address
3737 ROSCOMMON N, MARTINEZ, GA 30907-4741
(706) 860-9996
(706) 868-7497
Mailing address
3737 ROSCOMMON N, MARTINEZ, GA 30907-4741
(706) 860-9996
(706) 868-7497
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT001132
GA
225XP0200X
Pediatric Occupational Therapist
OT001132
GA
235Z00000X
Speech-Language Pathologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10040545
AMERIGROUP
GA
01
—
308521
WELLCARE
GA
Enumeration date
12/21/2006
Last updated
09/11/2025
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