Individual
MRS. POONAM ANIL PRADHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
4360 KENION FOREST DR, LILBURN, GA 30047-4185
(770) 381-5054
Mailing address
4360 KENION FOREST DR, LILBURN, GA 30047-4185
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003564
GA
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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