Provider Demographics
NPI:1194581371
Name:GEORGIA, EMILY KAITLIN (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:KAITLIN
Last Name:GEORGIA
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 PINE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-9675
Mailing Address - Country:US
Mailing Address - Phone:570-955-6566
Mailing Address - Fax:
Practice Address - Street 1:419 VILLAGE DR STE B
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-6943
Practice Address - Country:US
Practice Address - Phone:717-446-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019131225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist