Individual
ERICA SAMPLE STASNY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
6884 HICKORY FLAT HWY, WOODSTOCK, GA 30188-3229
(770) 704-8244
Mailing address
234 PARC DR, CANTON, GA 30114-7741
(803) 608-2527
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005760
GA
Other
Enumeration date
08/23/2024
Last updated
08/23/2024
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