Individual
MELCHOR CAPUYAN GOMEYAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2130 ANDERSON MILL RD, AUSTELL, GA 30106-1806
(770) 941-8813
Mailing address
1145 WINDBROOKE DR, POWDER SPRINGS, GA 30127-8001
(770) 354-3627
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003875
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050435559
DRIVER'S LICENSE
GA
01
—
OT003875
OT LICENSE
GA
Enumeration date
09/20/2018
Last updated
09/20/2018
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