Individual
TIFFANI WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3950 COBB PKWY NW, ACWORTH, GA 30101-9532
(678) 533-9643
Mailing address
3950 COBB PKWY NW, ACWORTH, GA 30101-9532
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
GA
Other
Enumeration date
03/03/2014
Last updated
03/03/2014
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