Provider Demographics
NPI:1558047290
Name:ROBERTS, SHEMONICA KEANNE
Entity type:Individual
Prefix:
First Name:SHEMONICA
Middle Name:KEANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BEVERLY PARK CT
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-6028
Mailing Address - Country:US
Mailing Address - Phone:770-253-1835
Mailing Address - Fax:
Practice Address - Street 1:2280 HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1031
Practice Address - Country:US
Practice Address - Phone:770-683-6904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002108224ZF0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224ZF0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantFeeding, Eating & SwallowingGroup - Multi-Specialty