Healthcare Provider Details

I. General information

NPI: 1780210260
Provider Name (Legal Business Name): KIERA LINTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIERA LINTON OTR/L

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/17/2020
Certification Date: 03/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRING ST SE STE 100
GAINESVILLE GA
30501-3773
US

IV. Provider business mailing address

500 SPRING ST SE STE 100
GAINESVILLE GA
30501-3773
US

V. Phone/Fax

Practice location:
  • Phone: 770-615-7676
  • Fax: 770-615-0177
Mailing address:
  • Phone: 770-615-7676
  • Fax: 770-615-0177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT007687
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: