Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT005769 | GA |
NPI | 1013309087 |
---|---|
Provider Name | Ali Mahony |
First Address | Lawrenceville, GA 30043-7356 |
Second Address | Suwanee, GA 30024-8706 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2015 |
Last Update Date | 26/02/2015 |