Provider Demographics
NPI:1083078018
Name:JONES, LAURIS TAYLOR IV (COTA/L)
Entity Type:Individual
Prefix:MR
First Name:LAURIS
Middle Name:TAYLOR
Last Name:JONES
Suffix:IV
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1705
Mailing Address - Country:US
Mailing Address - Phone:404-425-1577
Mailing Address - Fax:
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1705
Practice Address - Country:US
Practice Address - Phone:404-425-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-06
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002060224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant