Provider Demographics
NPI:1497467591
Name:OKOT LYMPHEDEMA THERAPY, LLC
Entity Type:Organization
Organization Name:OKOT LYMPHEDEMA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:OKSANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KULIYEV
Authorized Official - Suffix:
Authorized Official - Credentials:MS, OT/R, CLT
Authorized Official - Phone:470-317-7488
Mailing Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30071-5736
Mailing Address - Country:US
Mailing Address - Phone:470-317-7488
Mailing Address - Fax:317-436-1199
Practice Address - Street 1:4720 PEACHTREE INDUSTRIAL BLVD STE 103
Practice Address - Street 2:
Practice Address - City:BERKELEY LAKE
Practice Address - State:GA
Practice Address - Zip Code:30071-5736
Practice Address - Country:US
Practice Address - Phone:470-317-7488
Practice Address - Fax:317-436-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty