Individual
PHU THO SRIKANCHANA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1894 LUDOVIE LN, DECATUR, GA 30033-1044
(678) 626-0557
Mailing address
2504 OLD NORCROSS RD, TUCKER, GA 30084-3119
(404) 423-2038
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT008486
GA
Other
Enumeration date
05/31/2023
Last updated
05/31/2023
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