Individual
ANN SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTRL
Contact information
Practice address
4420 SHILLHAM CT, CUMMING, GA 30040-1541
(404) 550-9476
Mailing address
4420 SHILLHAM CT, CUMMING, GA 30040-1541
(404) 550-9476
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
3368
SC
225XP0200X
Pediatric Occupational Therapist
Primary
OT003970
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
368569697C
—
GA
Enumeration date
12/13/2006
Last updated
06/26/2015
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