Provider Demographics
NPI:1922852425
Name:KAYLOR, KELLY (COTA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KAYLOR
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 ETRIS RD STE F100
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1470
Mailing Address - Country:US
Mailing Address - Phone:404-229-8166
Mailing Address - Fax:
Practice Address - Street 1:12060 ETRIS RD STE F100
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1470
Practice Address - Country:US
Practice Address - Phone:404-229-8166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003030224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant