Individual
PATRICIA GRACE ENNIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
1071 THOMAS AVE, WATKINSVILLE, GA 30677-6073
(706) 224-9154
Mailing address
511 LACEBARK DR, ATHENS, GA 30605-5751
(757) 876-2796
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005419
GA
Other
Enumeration date
11/26/2017
Last updated
03/15/2018
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