Active NPI
Stephanie Diane Wade
- Occupational Therapist
- Peachtree Corners, GA
National Provider Identifier
1659830149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 007284
- Practice address
- 5701 Spalding Dr
Peachtree Corners, GA 30092-2405 - Phone
- (770) 416-0502
- NPI assigned
- Mar 14, 2019
- Sex
- Female
- Sole proprietor
- No
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 Therapist | 225X00000X | 007284 | GA | Primary |
Addresses
Primary practice location
5701 Spalding Dr
Peachtree Corners, GA 30092-2405
Mailing address
974 N Carter Rd
Decatur, GA 30030-4701
Phone (205) 777-9666
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 007284 | GA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1552521600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1552521600000",
"number": "1659830149",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "974 N CARTER RD",
"city": "DECATUR",
"state": "GA",
"postal_code": "300304701",
"telephone_number": "205-777-9666"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5701 SPALDING DR",
"city": "PEACHTREE CORNERS",
"state": "GA",
"postal_code": "300922405",
"telephone_number": "770-416-0502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "STEPHANIE",
"middle_name": "DIANE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-14",
"last_updated": "2019-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "GA",
"license": "007284",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peachtree Corners, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.