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General NPI Number Information
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NPI Number | 1619572252
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Entity Type | Individual
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Provider Name | MORSE CALVIN MERRIWETHER III COTA/L
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Gender | Male
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Dates
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Enumeration Date | 12/02/2020
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Last Update Date | 12/02/2020
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Provider Practice Location Address
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Address Line | 3930 FLAKES MILL RD
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City | DECATUR
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State | GA
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Zip | 30034-5829
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Country | US
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Telephone | 770-771-8277
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Fax |
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Provider Business Mailing Address
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Address Line | 3930 FLAKES MILL RD
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City | DECATUR
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State | GA
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Zip | 30034-5829
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Country | US
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Telephone | 770-771-8277
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA002041
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License Number State | GA
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