Individual
LESLIE CHITWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
613 COOK ST, ROYSTON, GA 30662-3933
(706) 491-5409
Mailing address
613 COOK ST, ROYSTON, GA 30662-3933
(706) 491-5409
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT001245
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT001245
LICENSE
GA
Enumeration date
06/10/2020
Last updated
06/10/2020
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