Individual
LAURA WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
6478 PUTNAM FORD DR STE 124, WOODSTOCK, GA 30189-6987
(404) 234-1370
Mailing address
3760 SIXES RD STE 126-235, CANTON, GA 30114-8192
(404) 234-1370
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT003110
GA
225XP0200X
Pediatric Occupational Therapist
Primary
OT003110
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000948645B
—
GA
05
—
000948648B
—
GA
Enumeration date
10/02/2006
Last updated
10/17/2019
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