Individual
DIANE BARDINA KORZENIEWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Mailing address
1813 WATUGA DR, GAINESVILLE, GA 30501-1549
(770) 287-1689
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003986
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10037631
AMERIGROUP-AAKTS
GA
05
—
183063315A
—
GA
01
—
340243
WELLCARE-AAKTS
GA
Enumeration date
12/05/2006
Last updated
09/28/2010
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