Provider Demographics
NPI:1699564583
Name:HOLLOWAY, WESSLEIGH (OTD)
Entity type:Individual
Prefix:
First Name:WESSLEIGH
Middle Name:
Last Name:HOLLOWAY
Suffix:
Gender:
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 AUBURN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-1130
Mailing Address - Country:US
Mailing Address - Phone:770-904-6009
Mailing Address - Fax:
Practice Address - Street 1:2 CORPORATE BLVD NE STE 130
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-2027
Practice Address - Country:US
Practice Address - Phone:470-355-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009506225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist