Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CX0006X | Orientation and Mobility Training Provider | 1253 | GA |
Y | 225X00000X | Occupational Therapist | OT004672 | GA |
NPI | 1609042795 |
---|---|
Provider Name | Celecia Phillips |
First Address | Macon, GA 31217-6212 |
Second Address | Macon, GA 31217-6212 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2008 |
Last Update Date | 07/05/2008 |