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Individual

JOAN THIEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1509 ATKINSON RD, SUITE 1100, LAWRENCEVILLE, GA 30043-7986
(770) 995-2379
(770) 995-2385
Mailing address
1509 ATKINSON ROAD, SUITE 1100, LAWRENCEVILLE, GA 30043-4608
(770) 995-2379
(770) 995-2385

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
OT000091
GA
225XP0200X
Pediatric Occupational Therapist
Primary
OT000091
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000758744A
GA
05
10037769
GA
05
306062
GA
Enumeration date
11/30/2006
Last updated
10/05/2011
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