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Individual

KIRSTIE LEIGH LUGO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
400 MARIETTA HWY, ROSWELL, GA 30075-4706
(770) 609-4502
Mailing address
995 WILDE RUN CT, ROSWELL, GA 30075-7186
(757) 593-3633

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA001546
GA

Other

Enumeration date
10/05/2014
Last updated
10/05/2014
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