Individual
MRS. STEPHANIE BRAY PHONESAVANH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1081 ASHLAND DR, STATHAM, GA 30666-3403
(770) 725-9856
Mailing address
1081 ASHLAND DRIVE, STATHAM, GA 30666
(770) 725-9856
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003414
GA
Other
Enumeration date
07/28/2011
Last updated
07/28/2011
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