| Jennifer Robin Vistnes, OT | |
|
318 W Pike St, Suite 104, Lawrenceville, GA 30045-3234 | |
| (678) 377-2833 | |
| (678) 377-2882 |
| Full Name | Jennifer Robin Vistnes |
|---|---|
| Gender | Female |
| Speciality | Occupational Therapist |
| Location | 318 W Pike St, Lawrenceville, Georgia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730242926 | NPI | - | NPPES |
| 00840804B | Medicaid | GA | |
| 10037643 | Other | GA | AMERIGROUP PROVIDER NUMBE |
| 307939 | Other | GA | WELLCARE PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | 002800 (Georgia) | Primary |
| Provider Name | Integrated Therapy Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1326247248 PECOS PAC ID: 1153317300 Enrollment ID: O20040422000993 |
| Provider Name | Aegis Group Practice Llc |
|---|---|
| Provider Type | Part B Supplier - Clinic/group Practice |
| Provider Identifiers | NPI Number: 1881142750 PECOS PAC ID: 5193036432 Enrollment ID: O20150916001644 |
| Provider Name | Legacy Healthcare Services Inc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1528419751 PECOS PAC ID: 2163339722 Enrollment ID: O20160830000411 |
| Provider Name | Legacy Healthcare Services Inc |
|---|---|
| Provider Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
| Provider Identifiers | NPI Number: 1831619337 PECOS PAC ID: 2163339722 Enrollment ID: O20220916001457 |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer Robin Vistnes, OT 4521 Shiloh Rd, Loganville, GA 30052-3551 Ph: (770) 554-5896 | Jennifer Robin Vistnes, OT 318 W Pike St, Suite 104, Lawrenceville, GA 30045-3234 Ph: (678) 377-2833 |
Anna Wicks, Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 545 Old Norcross Rd, Suite 100, Lawrenceville, GA 30046 Phone: 678-377-2833 | |
Anna Kate Mccormick, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 545 Old Norcross Rd Ste 100, Lawrenceville, GA 30046 Phone: 678-377-2833 | |
Ms. Alexis Shakeena Zimmerman, M.S. OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 1130 Hurricane Shoals Rd Ne Ste 2300, Lawrenceville, GA 30043 Phone: 470-323-6711 | |
Kamille Rodriguez-olivo, MS, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 545 Old Norcross Rd, Suite 100, Lawrenceville, GA 30046 Phone: 678-377-2833 Fax: 678-377-2882 | |
Jennifer Lynn Drake, OTR/L Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 545 Old Norcross Rd, Suite 100, Lawrenceville, GA 30046 Phone: 678-377-2833 | |
Janet Tackett, OT Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 545 Old Norcross Rd, Suite 100, Lawrenceville, GA 30046 Phone: 678-377-2833 Fax: 678-377-2882 | |
Sarah Pirie Word, OT Occupational Therapist Medicare: Accepting Medicare Assignments Practice Location: 455 Philip Blvd Bldg 100-160, Lawrenceville, GA 30046 Phone: 678-985-0238 Fax: 678-985-0136 |