Provider Demographics
NPI:1336559335
Name:TUELL, CASEY (MOT, OTR/L)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:TUELL
Suffix:
Gender:
Credentials:MOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 HORSESHOE COVE RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:GA
Mailing Address - Zip Code:31565-2110
Mailing Address - Country:US
Mailing Address - Phone:850-294-4666
Mailing Address - Fax:
Practice Address - Street 1:1454 HORSESHOE COVE RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:GA
Practice Address - Zip Code:31565-2110
Practice Address - Country:US
Practice Address - Phone:850-294-4666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4299225X00000X
GAOT007478225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH2750Medicaid
SCGP6269Medicaid