Individual
CAROL ANN AVERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
179 SPANTON CRES, POOLER, GA 31322-9673
(912) 704-4277
Mailing address
179 SPANTON CRES, POOLER, GA 31322-9673
(912) 704-4277
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT.4075OT
SC
225X00000X
Occupational Therapist
OT005162
GA
Other
Enumeration date
11/03/2011
Last updated
03/01/2013
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