Individual
MISTY MYRICK COPELAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
318 KEEN RD, SUMMERVILLE, GA 30747-6379
(706) 857-8890
Mailing address
318 KEEN RD, SUMMERVILLE, GA 30747-6379
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA001260
GA
Other
Enumeration date
06/04/2019
Last updated
06/04/2019
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