Provider Demographics
NPI:1952018475
Name:LEWIS, MACY LEIGH (OT)
Entity Type:Individual
Prefix:MRS
First Name:MACY
Middle Name:LEIGH
Last Name:LEWIS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PETERSON AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31533-5244
Mailing Address - Country:US
Mailing Address - Phone:912-501-4047
Mailing Address - Fax:912-501-5289
Practice Address - Street 1:515 PETERSON AVE S STE B
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-5244
Practice Address - Country:US
Practice Address - Phone:912-501-4047
Practice Address - Fax:912-501-5289
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT008698225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist