MEDICARE: MIKAYLA ROLLE MSOT

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	OT26815	FL

General Provider Information

NPI Number	:	1679281679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAYLA ROLLE MSOT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	866-518-0283
Fax Number	:

Provider Business Practice Location Address
First Line	:	1275 HIGHWAY 54 W STE 200
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-4538
Country	:	US
Telephone Number	:	770-460-8609
Fax Number	:

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

Provider Enumeration Date	:	11/08/2022
Last Update Date	:	02/24/2026

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Directions to “ MIKAYLA ROLLE MSOT” Practice Location

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