1437429156 NPI number — MICHAELENE SAGE KEARNEY OTR/L.

Table of content: MICHAELENE SAGE KEARNEY OTR/L. (NPI 1437429156)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437429156 NPI number — MICHAELENE SAGE KEARNEY OTR/L.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEARNEY
Provider First Name:
MICHAELENE
Provider Middle Name:
SAGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR/L.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437429156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5655 PEACHTREE PKWY
Provider Second Line Business Mailing Address:
SUITE 117
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30092-2812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-798-9844
Provider Business Mailing Address Fax Number:
770-798-9832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5635 PEACHTREE PKWY
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
NORCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30092-2879
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-798-9844
Provider Business Practice Location Address Fax Number:
770-798-9832
Provider Enumeration Date:
01/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  OT000954 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com