Individual
MRS. MITZIE MARION COLET MICKELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L, CPAM
Contact information
Practice address
511 W 10TH ST NE, ROME, GA 30165-2652
(706) 235-0807
Mailing address
1501 SUMMER GATE WAY APT 12, DALTON, GA 30720-5385
(408) 218-4635
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004641
GA
Other
Enumeration date
08/20/2020
Last updated
08/20/2020
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