Individual
SUSAN MOCKALIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., OTR/L
Contact information
Practice address
304 EMORY ST, VALDOSTA, GA 31602-1808
(229) 244-1667
(229) 244-8253
Mailing address
2406 DAVIS AVE, TIFTON, GA 31794-3136
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006051
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT006051
GEORGIA STATE LICENSE
GA
Enumeration date
07/25/2016
Last updated
07/25/2016
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