Healthcare Provider Details

I. General information

NPI: 1235488487
Provider Name (Legal Business Name): TYLER O'MAR SEARS OTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2423 PINEY POINT LN
ATLANTA GA
30339-4125
US

IV. Provider business mailing address

2423 PINEY POINT LN
ATLANTA GA
30339-4125
US

V. Phone/Fax

Practice location:
  • Phone: 404-935-8679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number001646
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number008054
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: