Individual
LAURA CADLE WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
444 PARK WEST DR., GROVETOWN, GA 30809
(706) 868-6543
Mailing address
5003 FARMSTONE CT, EVANS, GA 30809-6074
(706) 651-9064
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003594
GA
Other
Enumeration date
11/29/2006
Last updated
07/09/2007
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