Individual
MRS. SAMANTHA CANNON MARTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSOT/L, CLT
Contact information
Practice address
145 VICTOR DR, BUFORD, GA 30518-2563
(770) 310-8100
Mailing address
145 VICTOR DR, BUFORD, GA 30518-2563
(770) 310-8100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
OT004468
GA
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
OT004468
GA
Other
Enumeration date
05/17/2014
Last updated
05/04/2022
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