Individual
BROOKE CRANNELL DIETERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
20471 GA HIGHWAY 144, RICHMOND HILL, GA 31324-5850
(561) 308-0452
Mailing address
20471 GA HIGHWAY 144, RICHMOND HILL, GA 31324-5850
(561) 308-0452
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005999
GA
Other
Enumeration date
09/15/2015
Last updated
09/15/2015
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