Provider Demographics
NPI:1962739995
Name:GAILES, ELIZABETH A (OTR/L)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GAILES
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 1:141 FUTRAL RD
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-7455
Mailing Address - Country:US
Mailing Address - Phone:770-229-5511
Mailing Address - Fax:770-233-0995
Practice Address - Street 1:141 FUTRAL RD
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-7455
Practice Address - Country:US
Practice Address - Phone:770-229-5511
Practice Address - Fax:770-233-0995
Is Sole Proprietor?:No
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT000570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist