Active NPI
Vilma Granger
- Occupational Therapy Assistant
- Loganville, GA
National Provider Identifier
1568874501
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA001741
- Practice address
- 580 Tommy Lee Fuller Dr
Loganville, GA 30052-3943 - Phone
- (770) 466-7388
- NPI assigned
- May 26, 2014
- Last updated
- May 26, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA001741 | GA | Primary |
Addresses
Primary practice location
580 Tommy Lee Fuller Dr
Loganville, GA 30052-3943
Mailing address
1441 Yorkton CT
Stone Mountain, GA 30083-5549
Phone (301) 792-8085
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA001741 | GA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1401062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1401062400000",
"number": "1568874501",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1441 YORKTON CT",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300835549",
"telephone_number": "301-792-8085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 TOMMY LEE FULLER DR",
"city": "LOGANVILLE",
"state": "GA",
"postal_code": "300523943",
"telephone_number": "770-466-7388"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANGER",
"first_name": "VILMA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-05-26",
"last_updated": "2014-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "GA",
"license": "OTA001741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Loganville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.