Individual
MISTY RACHAE HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
809 S BROAD ST SW, ROME, GA 30161-4654
(706) 235-1337
Mailing address
272 SUNSET DR, SUMMERVILLE, GA 30747-7045
(706) 331-5113
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA001135
GA
Other
Enumeration date
11/21/2012
Last updated
11/21/2012
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