Tracy Medlin, OTR/L

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

OT004265 Issued in GA

Practice address

5150 Stilesboro Rd NW
Suite 430
Kennesaw, GA 30152-7744

Phone

(770) 218-2300

Fax

(770) 218-2201

NPI assigned

Aug 20, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Cobb Speech & Language Services

  • Speech-Language Pathologist
  • Marietta, GA
  • NPI 1316402803
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1801043971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 STILESBORO RD NW STE 210",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527742",
            "telephone_number": "404-384-3650",
            "fax_number": "786-573-4809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 STILESBORO RD NW",
            "address_2": "SUITE 430",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301527744",
            "telephone_number": "770-218-2300",
            "fax_number": "770-218-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLIN",
        "first_name": "TRACY",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT004265",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "GA",
            "license": "OT004265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "877080133A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hollie Elizabeth Means-Beaman, LCSW
• Medcare Supply LLC
• Medical National Medical Supply Company, LLC
• Medici Medical Arts
• Medisource Home Medical
• Diana Roya Mehrjooya
• Karma D Mehta, PA-C
• Maddison Capri Meijome, LICSW
• Hawii Mekonnen, OTR/L
• Mele Counseling, Inc.

• Pediatric Occupational Therapist in Kennesaw, GA
• Providers in Kennesaw, GA by specialty
• Pediatric Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.