Individual
MALLORY LANIER ROSCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHS
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-6246
(706) 721-8623
Mailing address
2315 CENTRAL AVE STE C, AUGUSTA, GA 30904-6246
(706) 364-6172
(706) 262-2893
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
04998
GA
Other
Enumeration date
10/20/2009
Last updated
10/29/2021
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