Individual
SAMANTHA A GUILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
5593 FORKWOOD DRIVE NW, ACWORTH, GA 30101
(678) 923-4295
(770) 919-1752
Mailing address
5593 FORKWOOD DRIVE NW, ACWORTH, GA 30101
(678) 923-4295
(770) 919-1752
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
23629986
NC
Other
Enumeration date
03/03/2009
Last updated
03/03/2009
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