Individual
MRS. MICHELLE LEA DISHNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1070 HARDSCRABBLE RD, ROSWELL, GA 30075-2204
(770) 354-0883
Mailing address
2648 E MADISON DR, ATLANTA, GA 30360-2027
(770) 354-0883
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003646
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT003646
SECRETARY OF STATE
GA
Enumeration date
04/22/2008
Last updated
10/18/2016
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