Individual
DIANE SIMONE STUKES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
3727 EXECUTIVE CENTER DR, AUGUSTA, GA 30907-2398
(706) 842-5330
(706) 842-5340
Mailing address
PO BOX 2567, AUGUSTA, GA 30903-2567
(706) 842-5330
(706) 842-5340
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-252400
GA
224Z00000X
Occupational Therapy Assistant
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Other
Enumeration date
01/18/2023
Last updated
01/18/2023
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