Provider Demographics
NPI:1609042795
Name:PHILLIPS, CELECIA (MOTR/L, COMS, CVRT)
Entity Type:Individual
Prefix:
First Name:CELECIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MOTR/L, COMS, CVRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3482 LANCING CT
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-6212
Mailing Address - Country:US
Mailing Address - Phone:478-718-4254
Mailing Address - Fax:
Practice Address - Street 1:3482 LANCING CT
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-6212
Practice Address - Country:US
Practice Address - Phone:478-718-4254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1253225CX0006X
GAOT004672225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training Provider