Individual
ASHLEY FOUNTAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 GARDINER RD, HOMER, GA 30547-3006
(706) 658-7656
Mailing address
425 GARDINER RD, HOMER, GA 30547-3006
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OT005179
GA
225X00000X
Occupational Therapist
Primary
OT009376
OH
Other
Enumeration date
01/26/2011
Last updated
03/17/2018
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