Provider Demographics
NPI:1891450508
Name:POSPISIL, CALLY B
Entity Type:Individual
Prefix:MRS
First Name:CALLY
Middle Name:B
Last Name:POSPISIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 SENOIA RD STE A1
Mailing Address - Street 2:
Mailing Address - City:TYRONE
Mailing Address - State:GA
Mailing Address - Zip Code:30290-1640
Mailing Address - Country:US
Mailing Address - Phone:678-632-6765
Mailing Address - Fax:678-550-7931
Practice Address - Street 1:1130 SENOIA RD STE A1
Practice Address - Street 2:
Practice Address - City:TYRONE
Practice Address - State:GA
Practice Address - Zip Code:30290-1640
Practice Address - Country:US
Practice Address - Phone:678-632-6765
Practice Address - Fax:678-550-7931
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008252225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics