Individual
MR. CARLOS MIKKEL WYNN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Mailing address
1550 CORNELL CT, STATHAM, GA 30666-2046
(706) 817-1663
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006330
GA
Other
Enumeration date
01/28/2016
Last updated
01/28/2016
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