Provider Demographics
NPI:1790852010
Name:FIELDS, MARLY WOOD (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARLY
Middle Name:WOOD
Last Name:FIELDS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:MARLY
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:340 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:GA
Mailing Address - Zip Code:31029-1669
Mailing Address - Country:US
Mailing Address - Phone:770-778-9379
Mailing Address - Fax:
Practice Address - Street 1:340 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:GA
Practice Address - Zip Code:31029-1669
Practice Address - Country:US
Practice Address - Phone:770-778-9379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003726225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics