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Individual

MARY DELAGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
130 N GROSS RD STE 125, KINGSLAND, GA 31548-6263
(912) 342-8875
(912) 265-0041
Mailing address
4212 CORAL PARK DR, BRUNSWICK, GA 31520-3016
(912) 342-8875
(912) 265-0041

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT007568
GA

Other

Enumeration date
11/02/2019
Last updated
11/02/2019
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