Provider Demographics
NPI:1154017374
Name:SHIRLEY, CODY REID (BS, COTA/L)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:REID
Last Name:SHIRLEY
Suffix:
Gender:M
Credentials:BS, COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 PEACHTREE ST NE UNIT 1409
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4892
Mailing Address - Country:US
Mailing Address - Phone:228-861-1083
Mailing Address - Fax:
Practice Address - Street 1:690 MOUNT VERNON HWY NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-4221
Practice Address - Country:US
Practice Address - Phone:404-843-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant