Individual
STEFANIE LEE WILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
470 S HILL STREET, BUFORD, GA 30518-3220
(678) 482-6100
(770) 932-5684
Mailing address
470 S HILL STREET, BUFORD, GA 30518
(678) 482-6100
(770) 932-5684
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003150
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000876103C
—
GA
Enumeration date
12/13/2006
Last updated
08/27/2008
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