Provider Demographics
NPI:1013157270
Name:TULLIS, CHRISTA PERRY (OT)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:PERRY
Last Name:TULLIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5005 FRIENDSHIP RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-1715
Mailing Address - Country:US
Mailing Address - Phone:770-271-3458
Mailing Address - Fax:770-271-8036
Practice Address - Street 1:100 SPRING ST
Practice Address - Street 2:SUITE B
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2565
Practice Address - Country:US
Practice Address - Phone:770-532-5721
Practice Address - Fax:770-532-5929
Is Sole Proprietor?:No
Enumeration Date:2009-03-02
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAOT004835225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist