Provider Demographics
NPI:1891374831
Name:ROY, ANNELIESE C (COTA)
Entity type:Individual
Prefix:
First Name:ANNELIESE
Middle Name:C
Last Name:ROY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:362 N VICTORIA RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-1492
Mailing Address - Country:US
Mailing Address - Phone:404-964-5119
Mailing Address - Fax:
Practice Address - Street 1:4355 GEORGETOWN SQ
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-6266
Practice Address - Country:US
Practice Address - Phone:770-644-0862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001679224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant