Individual
JENINE NICOLE AMPUDIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6035 PEACHTREE RD, ATLANTA, GA 30360-3230
(678) 514-3270
Mailing address
430 WOODHAVEN DR, DECATUR, GA 30030-1650
(404) 790-7583
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT008940
GA
Other
Enumeration date
10/06/2023
Last updated
10/06/2023
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