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Individual

TOMMY TANNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
COTA

Contact information

Practice address
3018 SPICEWOOD DR, AUGUSTA, GA 30909-6489
(706) 834-8219
Mailing address
3018 SPICEWOOD DR, AUGUSTA, GA 30909-6489

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA000595
GA

Other

Enumeration date
06/18/2019
Last updated
06/18/2019
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