Individual
MRS. STACY YOUNGBLOOD OESTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
444 PARK WEST DRIVE, GROVETOWN, GA 30813
(706) 868-6543
(706) 868-9579
Mailing address
4116 SHADY OAKS DR, MARTINEZ, GA 30907-7909
(706) 860-2028
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT003387
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00969482A
—
GA
Enumeration date
12/11/2006
Last updated
07/08/2007
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