Provider Demographics
NPI:1710661665
Name:TULLY, SARAANN (COTA)
Entity Type:Individual
Prefix:
First Name:SARAANN
Middle Name:
Last Name:TULLY
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:SARAANN
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:601 N BELAIR SQ STE 19
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4324
Mailing Address - Country:US
Mailing Address - Phone:706-831-1128
Mailing Address - Fax:770-230-0157
Practice Address - Street 1:601 N BELAIR SQ STE 19
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-4324
Practice Address - Country:US
Practice Address - Phone:706-831-1128
Practice Address - Fax:770-230-0157
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002983224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant