Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA001310 | GA |
NPI | 1023396009 |
---|---|
Provider Name | Carine N/a Castor |
First Address | Mcdonough, GA 30253-5936 |
Second Address | Mcdonough, GA 30253-5936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2011 |
Last Update Date | 25/07/2011 |