Individual
SUE E GONZALEZ WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1061 HARMON AVE, FORT STEWART, GA 31314-5641
(912) 348-6376
Mailing address
241 FLINT CREEK DR, RICHMOND HILL, GA 31324-3716
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002003
GA
Other
Enumeration date
06/22/2017
Last updated
06/22/2017
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