Provider Demographics
NPI:1700359973
Name:OLELE, JULIET EZIAFA (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:EZIAFA
Last Name:OLELE
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 1:4630 BRIDLE POINT PKWY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-2776
Mailing Address - Country:US
Mailing Address - Phone:678-891-9168
Mailing Address - Fax:
Practice Address - Street 1:1865 BOLD SPRINGS RD NW
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30656-4605
Practice Address - Country:US
Practice Address - Phone:770-267-8618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-09
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007238225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist