Individual
HOLLY GEORGIANA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1401 TIFT AVE N STE B, TIFTON, GA 31794-3577
(229) 396-5644
(855) 565-1769
Mailing address
69 ATWATER RD, TIFTON, GA 31794-8513
(229) 392-6922
(855) 565-1769
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002554
GA
Other
Enumeration date
11/28/2022
Last updated
11/28/2022
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