Provider Demographics
NPI:1912661570
Name:GUYTON, TALISIA (COTA/L)
Entity Type:Individual
Prefix:
First Name:TALISIA
Middle Name:
Last Name:GUYTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 BARRETT LAKES BLVD NW APT 1024
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-7532
Mailing Address - Country:US
Mailing Address - Phone:813-739-9945
Mailing Address - Fax:
Practice Address - Street 1:100 WHITLOCK AVE NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2362
Practice Address - Country:US
Practice Address - Phone:770-872-0767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA002345224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant