Jennifer Deslich, O.T.
Individual provider Active NPI Occupational Therapist · Clayton, GA
NPI 1790107993 · NPPES record last updated Sep 27, 2023
Key facts
- NPI
- 1790107993
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- OT005828 (GA)
- Practice address
- 165 Ridgecrest Cir Ste B
Clayton, GA 30525-4196 - Phone
- (678) 357-5849
- Fax
- (706) 534-6750
- NPI assigned
- Jan 8, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Fundamental Therapy Services LLC
Practice addresses (Care Compare)
165 Ridgecrest Cir
Clayton, GA 30525-4110
Phone (678) 357-5849
4649 E Wolf Creek Rd
Tiger, GA 30576-2946
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181013000059 | GA | Practitioner - Occupational Therapist in Private Practice | 2365794799 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fundamental Therapy Services, LLC | Occupational Therapist | Current |
Accepting new patients |
Locations
165 Ridgecrest Cir
Clayton, GA 30525
Phone (678) 357-5849
165 Ridgecrest Cir
Ste B
Clayton, GA 30525
Phone (678) 357-5849
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Feeding, Eating & Swallowing Occupational Therapist | 225XF0002X | 15112 | NC | |
| Pediatric Occupational Therapist | 225XP0200X | 15112 | NC | |
| Occupational Therapist | 225X00000X | OT005828 | GA | Yes |
Addresses
Primary practice location
165 Ridgecrest Cir Ste B
Clayton, GA 30525-4196
Mailing address
4649 E Wolf Creek Rd
Tiger, GA 30576-2946
Phone (678) 357-5849
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003141022A | Medicaid | GA |
Other providers in Clayton, GA
- Danny Stevens Hammons
- Tracy Ellen Dasher
- James Todd Davidson
- Patti Denike
- Dental Professionals of Georgia, P.C.
- Veronica Dono
- Kathy Donovan
- Allison Dooley
- Dosher Physical Therapy Associates, Inc
- Abraham Jacob Duncan
All providers in Clayton, GA · Occupational Therapist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.