Individual
GLORIA DELORES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
652 N COASTAL HWY, MIDWAY, GA 31320-3432
(912) 880-4508
Mailing address
652 N COASTAL HWY, MIDWAY, GA 31320-3432
(912) 880-4508
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000933
GA
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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