Individual
MRS. MIA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,OTR,CHT
Contact information
Practice address
11180 STATE BRIDGE RD, SUITE 305, ALPHARETTA, GA 30022-7482
(678) 992-0303
(678) 992-0302
Mailing address
2285 HAMPTONS XING, ALPHARETTA, GA 30005-7415
(404) 308-3820
(678) 992-0302
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT000932
GA
225XH1200X
Hand Occupational Therapist
OT000932
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
501099970B
—
GA
Enumeration date
11/30/2006
Last updated
08/16/2019
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