Provider Demographics
NPI:1639571151
Name:DILEO, CARLY (OT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:DILEO
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 1:1123 OXFORD CRES NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-1624
Mailing Address - Country:US
Mailing Address - Phone:404-247-7959
Mailing Address - Fax:404-459-6566
Practice Address - Street 1:1123 OXFORD CRES NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1624
Practice Address - Country:US
Practice Address - Phone:404-247-7959
Practice Address - Fax:404-459-6566
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005710225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist