Provider Demographics
NPI:1164992475
Name:PEEPLES, KAYLA (OT)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:PEEPLES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 HIGHWAY 314 STE B
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7813
Mailing Address - Country:US
Mailing Address - Phone:404-994-7727
Mailing Address - Fax:
Practice Address - Street 1:290 HIGHWAY 314 STE B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7813
Practice Address - Country:US
Practice Address - Phone:404-994-7727
Practice Address - Fax:404-994-7728
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007218225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist