Individual
MRS. CHENE WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
5050 RESEARCH CT, SUITE 800, SUWANEE, GA 30024-6606
(770) 205-5551
Mailing address
5050 RESEARCH CT, SUITE 800, SUWANEE, GA 30024-6606
(770) 205-5551
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003813
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
330870519A
—
GA
05
—
330870519B
—
GA
Enumeration date
01/08/2007
Last updated
02/14/2017
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