Individual
STEPHANIE MCHENRY MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
101 DEVANT ST STE 703, FAYETTEVILLE, GA 30214-2717
(770) 847-6760
(404) 393-6718
Mailing address
101 DEVANT ST STE 703, FAYETTEVILLE, GA 30214-2717
(770) 847-6760
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA000570
GA
Other
Enumeration date
07/18/2022
Last updated
07/18/2022
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