Individual
MISS KEISHA MONIQUE SPRINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
5787 MITCHELL CHASE TRL, MABLETON, GA 30126-3473
(678) 613-0001
Mailing address
PO BOX 360710, DECATUR, GA 30036-0710
(678) 613-0001
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
002668
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002668
LICENSE
IN
Enumeration date
09/13/2007
Last updated
09/13/2007
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