Individual
MRS. MARIANNE BEVILACQUA-HARDING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1774 GENTRY LN, STATHAM, GA 30666-2059
(484) 883-0919
Mailing address
1774 GENTRY LN, STATHAM, GA 30666-2059
(484) 883-0919
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC006148L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1020403110001
PROMISE PROVIDER ID#
PA
Enumeration date
09/26/2007
Last updated
01/06/2015
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