Provider Demographics
NPI:1174167860
Name:LITTLE, LIBBY KELLAR (OTR/L)
Entity type:Individual
Prefix:
First Name:LIBBY
Middle Name:KELLAR
Last Name:LITTLE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:ANNE
Other - Last Name:KELLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 HENRY DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4158
Mailing Address - Country:US
Mailing Address - Phone:404-935-8172
Mailing Address - Fax:
Practice Address - Street 1:1270 MCCONNELL DR STE B
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-3507
Practice Address - Country:US
Practice Address - Phone:770-892-6879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2023-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007550225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist