Provider Demographics
NPI:1275120024
Name:GUILLERMO, PIERRE (OTR/L)
Entity Type:Individual
Prefix:
First Name:PIERRE
Middle Name:
Last Name:GUILLERMO
Suffix:
Gender:M
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 1:1335 CRESTBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2881
Mailing Address - Country:US
Mailing Address - Phone:770-862-2087
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE STE 150
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5191
Practice Address - Country:US
Practice Address - Phone:770-433-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist