Individual
WAYNE RICHARD DEFOREST II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
1013 RIVERBURCH PKWY, SUITE 4, DALTON, GA 30721-8887
(866) 261-8090
(706) 226-7869
Mailing address
1013 RIVERBURCH PKWY, SUITE 4, DALTON, GA 30721-8887
(866) 261-8090
(706) 226-7869
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT002653
GA
Other
Enumeration date
06/03/2009
Last updated
06/03/2009
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