Provider Demographics
NPI:1083992069
Name:LOUIS, MARIE PIERRE GRETCHAIDA (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:MARIE PIERRE
Middle Name:GRETCHAIDA
Last Name:LOUIS
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 1:620 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-6444
Mailing Address - Country:US
Mailing Address - Phone:770-629-5766
Mailing Address - Fax:
Practice Address - Street 1:110 BRANDYWINE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1500
Practice Address - Country:US
Practice Address - Phone:770-461-4279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA1281224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant