Individual
ANNETTE MOCK CRENSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
215 JEP WHEELER RD, WOODSTOCK, GA 30188-6501
(678) 923-1088
Mailing address
215 JEP WHEELER RD, WOODSTOCK, GA 30188-6501
(678) 923-1088
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
720022501A
—
GA
Enumeration date
02/08/2010
Last updated
02/08/2010
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