Individual
STEPHANIE CRISWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1312 TREES OF KENNESAW PKWY NW, KENNESAW, GA 30152-7657
(814) 574-5460
Mailing address
1312 TREES OF KENNESAW PKWY NW, KENNESAW, GA 30152-7657
(814) 574-5460
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA001167
GA
Other
Enumeration date
11/21/2012
Last updated
11/23/2012
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