Individual
PATEN LANE WILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
310 PAPER TRAIL WAY, STE 302, CANTON, GA 30115-5203
(770) 345-2804
(678) 827-0927
Mailing address
310 PAPER TRAIL WAY, STE 302, CANTON, GA 30115-5203
(770) 345-2804
(678) 827-0927
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT005366
GA
Other
Enumeration date
10/27/2011
Last updated
10/27/2011
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