Individual
MARIA FIDELA MENDIOLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
118 HERRON ST, FORT OGLETHORPE, GA 30742-3126
(706) 861-7471
Mailing address
118 HERRON ST, FORT OGLETHORPE, GA 30742-3126
(706) 861-7471
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT007073
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT007073
OT LICENSE
GA
Enumeration date
07/26/2018
Last updated
07/26/2018
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