Individual
KATHLEEN SOPHIA MELOY LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 S PARK ST STE 1, CARROLLTON, GA 30117-4412
(770) 834-7436
Mailing address
812 S PARK ST STE 1, CARROLLTON, GA 30117-4412
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT009089
GA
Other
Enumeration date
03/22/2024
Last updated
03/28/2024
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