Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | GA |
NPI | 1003474875 |
---|---|
Provider Name | Amber Cooper |
First Address | Sumner, GA 31789-4232 |
Second Address | Tifton, GA 31794-3752 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2019 |
Last Update Date | 05/06/2019 |