Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003431941 |
---|---|
Provider Name | Anna Kate Mccormick |
First Address | Marietta, GA 30060-2019 |
Second Address | Lawrenceville, GA 30046-3390 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2020 |
Last Update Date | 16/07/2020 |