Provider Demographics
NPI:1750831590
Name:ALLAWAY, ALLYA (COTA/L)
Entity Type:Individual
Prefix:
First Name:ALLYA
Middle Name:
Last Name:ALLAWAY
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 ESTUARY TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3071
Mailing Address - Country:US
Mailing Address - Phone:404-825-5656
Mailing Address - Fax:678-922-7124
Practice Address - Street 1:2295 HENRY CLOWER BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5707
Practice Address - Country:US
Practice Address - Phone:770-995-9600
Practice Address - Fax:678-922-7124
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001897224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant