Individual
KIMBERLY CROCKETT HAYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2465 CANOPY GLN, MARIETTA, GA 30066-1541
(770) 517-2480
(770) 592-9431
Mailing address
PO BOX 670207, MARIETTA, GA 30066-0121
(770) 517-2480
(770) 592-9431
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
928
GA
225XP0200X
Pediatric Occupational Therapist
928
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
928
OCCUPATIONAL LICENSE
GA
Enumeration date
03/05/2008
Last updated
03/05/2008
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