Individual
MARY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L, CHT
Contact information
Practice address
2155 POST OAK TRITT RD, SUITE 400, MARIETTA, GA 30062-8620
(770) 565-4044
Mailing address
PO BOX 518, JONESBORO, GA 30237
(770) 631-8277
(770) 631-9403
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
GA001439
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GA001439
STATE LISC NUMBER
GA
Enumeration date
11/03/2006
Last updated
07/08/2007
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