Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003360223 |
---|---|
Provider Name | Barbara Williamson |
First Address | Grayson, GA 30017-1675 |
Second Address | Duluth, GA 30096-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2016 |
Last Update Date | 07/11/2017 |