Provider Demographics
NPI:1447373774
Name:NIENABER, MARGARETHE MICHELLE (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARGARETHE
Middle Name:MICHELLE
Last Name:NIENABER
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2387 ROSEBERRY LN
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1502
Mailing Address - Country:US
Mailing Address - Phone:770-982-3465
Mailing Address - Fax:
Practice Address - Street 1:2519 PARKWOOD RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-4403
Practice Address - Country:US
Practice Address - Phone:678-344-6821
Practice Address - Fax:770-985-8758
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003866225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist