Provider Demographics
NPI:1295597862
Name:HAMBORG, CAYLEY (OTR/L)
Entity type:Individual
Prefix:
First Name:CAYLEY
Middle Name:
Last Name:HAMBORG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 CARROLL ALY
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-3524
Mailing Address - Country:US
Mailing Address - Phone:478-972-1149
Mailing Address - Fax:
Practice Address - Street 1:1013 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-4313
Practice Address - Country:US
Practice Address - Phone:478-224-1440
Practice Address - Fax:478-224-1441
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT009024225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist