Individual
CRISANY LAUREN CARROLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
22 BUFORD VILLAGE WAY, BUFORD, GA 30518-8846
(678) 936-1727
Mailing address
2275 QUAIL CREEK TER, BUFORD, GA 30519-7019
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT007057
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT007057
GEORGIA BOARD OF OCCUPATIONAL THERAPY
GA
Enumeration date
06/05/2018
Last updated
06/05/2018
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