Individual
JACQUELINE R SUMMERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1200 LAKE HEARN DR NE, SUITE 250, ATLANTA, GA 30319-1415
(404) 943-1070
(404) 943-0890
Mailing address
5635 STONINGTON TRACE PKWY, STONE MOUNTAIN, GA 30087-5248
(770) 879-8078
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002477
GA
225X00000X
Occupational Therapist
OY002477
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
028577889
DRIVERS LICENSE
GA
Enumeration date
05/20/2008
Last updated
07/15/2020
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