Provider Demographics
NPI:1316689912
Name:MOTT, ABBEY JILLIAN (OTR/L)
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:JILLIAN
Last Name:MOTT
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 J DEWEY GRAY CIR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-1867
Mailing Address - Country:US
Mailing Address - Phone:706-863-9797
Mailing Address - Fax:
Practice Address - Street 1:3650 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-1867
Practice Address - Country:US
Practice Address - Phone:706-863-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008616225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
15555525OtherCAQH NUMBER