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Individual

MRS. MARY R. VIGNERI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
223 BAINBRIDGE DR, EVANS, GA 30809-8245
(706) 833-6686
Mailing address
223 BAINBRIDGE DR, EVANS, GA 30809-8245
(706) 833-6686

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1413
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
TH0641
SC
Enumeration date
07/13/2006
Last updated
07/09/2007
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