Provider Demographics
NPI:1184316218
Name:WITTMEYER, DAYLA DEESE
Entity type:Individual
Prefix:MRS
First Name:DAYLA
Middle Name:DEESE
Last Name:WITTMEYER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DAYLA
Other - Middle Name:SHEREE
Other - Last Name:DEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-4308
Mailing Address - Country:US
Mailing Address - Phone:404-402-7633
Mailing Address - Fax:
Practice Address - Street 1:121 CARTER AVE
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4308
Practice Address - Country:US
Practice Address - Phone:404-402-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0001576224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant