Provider Demographics
NPI:1699227231
Name:SAWYER, JUSTIN ASLING (COTA)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:ASLING
Last Name:SAWYER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7367 SPOUT SPRINGS RD
Mailing Address - Street 2:STE 125
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542-5519
Mailing Address - Country:US
Mailing Address - Phone:770-965-1861
Mailing Address - Fax:770-965-1863
Practice Address - Street 1:7367 SPOUT SPRINGS RD
Practice Address - Street 2:STE 125
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-5519
Practice Address - Country:US
Practice Address - Phone:770-965-1861
Practice Address - Fax:770-965-1863
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002161224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant