Provider Demographics
NPI:1093571390
Name:WEILER, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WEILER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4876 TWIN LAKES TRL
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 PHIPPS BLVD NE
Practice Address - Street 2:
Practice Address - City:ATLANATA
Practice Address - State:GA
Practice Address - Zip Code:30326
Practice Address - Country:US
Practice Address - Phone:470-764-3962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002492224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant