Provider Demographics
NPI:1255643789
Name:COYLE, ALLISON MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARIE
Last Name:COYLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8109 DEER TRL
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8575
Mailing Address - Country:US
Mailing Address - Phone:386-747-6407
Mailing Address - Fax:
Practice Address - Street 1:5991 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1342
Practice Address - Country:US
Practice Address - Phone:770-205-5551
Practice Address - Fax:770-205-5581
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT005121225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist