Individual
MARY GOWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
739 WEST PEACHTREE STREET NW, ATLANTA, GA 30308-1137
(404) 602-4318
(404) 607-0062
Mailing address
739 WEST PEACHTREE STREET. NW, ATLANTA, GA 30044-1137
(404) 602-4318
(404) 607-0062
Taxonomy
Speciality
Code
Description
License number
State
225XL0004X
Low Vision Occupational Therapist
Primary
OT006081
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497893671
MEDICARE GRP7122
GA
01
—
58-1168874
58-1168874
GA
Enumeration date
11/21/2014
Last updated
11/21/2014
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