Individual
PAMELA WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
9620 HIGHWAY 109, ZEBULON, GA 30295-3445
(770) 584-0081
Mailing address
PO BOX 5013, THOMASTON, GA 30286-0019
(770) 584-0081
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002179
GA
Other
Enumeration date
03/23/2016
Last updated
03/23/2016
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