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Individual

ELIZABETH A THALER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
2465 CANOPY GLN, MARIETTA, GA 30066-1541
(770) 517-2480
(770) 592-9431
Mailing address
PO BOX 670207, MARIETTA, GA 30066-0121
(770) 517-2480
(770) 592-9431

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2323
GA
225XP0200X
Pediatric Occupational Therapist
Primary
2323
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10040457
AMERIGROUP
GA
01
2323
OCCUPATIONAL THERAPY LIC
GA
01
318303
WELLCARE
GA
Enumeration date
12/11/2006
Last updated
09/11/2025
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