Provider Demographics
NPI:1073918397
Name:MCINTYRE, COREY L (OTR/L)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:L
Last Name:MCINTYRE
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 1:2061 PEACHTREE RD NE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1447
Mailing Address - Country:US
Mailing Address - Phone:404-352-3522
Mailing Address - Fax:404-352-9251
Practice Address - Street 1:2061 PEACHTREE RD NE
Practice Address - Street 2:SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1447
Practice Address - Country:US
Practice Address - Phone:404-352-3522
Practice Address - Fax:404-352-9251
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT006028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist