Individual
MARY KAVISHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
3985 STEVE REYNOLDS BLVD, BLD G, NORCROSS, GA 30093-3035
(770) 622-2532
(770) 622-2534
Mailing address
3985 STEVE REYNOLDS BLVD, BLD G, NORCROSS, GA 30093-3035
(770) 622-2532
(770) 622-2534
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005087
GA
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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