Individual
DONAE CANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
311 COOPER RD, LOGANVILLE, GA 30052-4976
(678) 205-5437
Mailing address
311 COOPER RD, LOGANVILLE, GA 30052-4976
(678) 205-5437
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT003337
GA
225X00000X
Occupational Therapist
Primary
OT003337
GA
225XP0200X
Pediatric Occupational Therapist
OT003337
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10037742
—
GA
05
—
306067
—
GA
05
—
863729177A
—
GA
Enumeration date
12/13/2006
Last updated
12/30/2010
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