Individual
WALT COLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
118 AZALEA RD STE 11, BAXLEY, GA 31513-9197
(912) 705-2855
Mailing address
118 AZALEA RD STE 11, BAXLEY, GA 31513-9197
(912) 705-2855
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006364
GA
Other
Enumeration date
05/20/2020
Last updated
05/20/2020
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