Provider Demographics
NPI:1699595983
Name:CARTLEDGE, LIRITA RACHA (COTA/L)
Entity type:Individual
Prefix:
First Name:LIRITA
Middle Name:RACHA
Last Name:CARTLEDGE
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 CHAMBERS DR
Mailing Address - Street 2:
Mailing Address - City:HEPHZIBAH
Mailing Address - State:GA
Mailing Address - Zip Code:30815-4485
Mailing Address - Country:US
Mailing Address - Phone:706-496-0557
Mailing Address - Fax:
Practice Address - Street 1:3235 DEANS BRIDGE RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30906-7004
Practice Address - Country:US
Practice Address - Phone:706-798-1430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-12
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001125224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant