Individual
MRS. KAREN GLOVER AGBONGHAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSOTR/L
Contact information
Practice address
809 S BROAD ST SW, ROME, GA 30161-4654
(706) 235-1337
Mailing address
3625 REGENT DR NW, KENNESAW, GA 30144-1175
(770) 425-6161
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004120
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT004120
OCCUPATIONAL THERAPY CERTIFICATION
GA
Enumeration date
12/16/2012
Last updated
12/16/2012
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