Provider Demographics
NPI:1922830066
Name:PEDIATRIC OT CONNECTIONS INC
Entity type:Organization
Organization Name:PEDIATRIC OT CONNECTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HOSTETLER
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:706-346-4666
Mailing Address - Street 1:30 NICKLAUS DR NW
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-9518
Mailing Address - Country:US
Mailing Address - Phone:706-346-4666
Mailing Address - Fax:
Practice Address - Street 1:30 NICKLAUS DR NW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-9518
Practice Address - Country:US
Practice Address - Phone:706-346-4666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty