Individual
TINA LYTTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1151 GULFPORT RUN, GRAYSON, GA 30017-2963
(770) 296-5177
Mailing address
1151 GULFPORT RUN, GRAYSON, GA 30017-2963
(770) 296-5177
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
004715
GA
Other
Enumeration date
10/08/2014
Last updated
11/14/2017
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