Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT006175 | GA |
N | 225XM0800X | Mental Health | OT006175 | GA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT006175 | GA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT006175 | GA |
NPI | 1679960561 |
---|---|
Provider Name | Christina Samar Khal |
First Address | Augusta, GA 30904-4887 |
Second Address | Augusta, GA 30904-4887 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2015 |
Last Update Date | 20/04/2015 |