Provider Demographics
NPI:1497810295
Name:SEVER, JEAN MARKLEY (MSOTRL)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARKLEY
Last Name:SEVER
Suffix:
Gender:F
Credentials:MSOTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 MENLO DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30340-5116
Mailing Address - Country:US
Mailing Address - Phone:770-842-6328
Mailing Address - Fax:
Practice Address - Street 1:1000 HOLCOMB WOODS PKWY
Practice Address - Street 2:STE426
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2575
Practice Address - Country:US
Practice Address - Phone:770-851-9553
Practice Address - Fax:770-698-4178
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002505225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA985589OtherBCBS