Individual
MADISON ABIGAIL LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
125 SAMARITAN DR, CUMMING, GA 30040-2354
(770) 889-0120
Mailing address
1270 HILLCREST DR APT 4408, SUGAR HILL, GA 30518-3740
(540) 632-3543
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT009337
GA
Other
Enumeration date
09/18/2024
Last updated
10/04/2024
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