Individual
MS. AILEEN DEOGRACIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4230 GRAND TETON PKWY, SUWANEE, GA 30024-3096
(770) 568-1099
Mailing address
4230 GRAND TETON PKWY, SUWANEE, GA 30024-3096
(770) 568-1099
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
9136
CA
225X00000X
Occupational Therapist
Primary
OT 004155
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT004155
GEORGIA STATE BOARD OF OCCUPATIONAL THERAPY
GA
Enumeration date
07/11/2014
Last updated
08/31/2015
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