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Individual

MRS. DONNA REID GRAHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA/L

Contact information

Practice address
4355 BARWICK RD, QUITMAN, GA 31643-4805
(229) 977-1590
(229) 224-5002
Mailing address
4355 BARWICK RD, QUITMAN, GA 31643-4805
(229) 977-1590
(229) 224-5002

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA000479
GA
224Z00000X
Occupational Therapy Assistant
OTA12259
FL

Other

Enumeration date
05/30/2012
Last updated
05/30/2012
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