MEDICARE: ALLISON MARIE COYLE OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OT005121	GA

General Provider Information

NPI Number	:	1255643789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON MARIE COYLE OTR/L

Provider Business Mailing Address
First Line	:	8109 DEER TRL
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-8575
Country	:	US
Telephone Number	:	386-747-6407
Fax Number	:

Provider Business Practice Location Address
First Line	:	5991 PARKWAY NORTH BLVD
Second Line	:	SUITE A
City	:	CUMMING
State	:	GA
Zip	:	30040-1342
Country	:	US
Telephone Number	:	770-205-5551
Fax Number	:	770-205-5581

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2010
Last Update Date	:	07/13/2010

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