Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 000668 | GA |
NPI | 1003225624 |
---|---|
Provider Name | Deborah Durden |
First Address | Byron, GA 31008-3923 |
Second Address | Byron, GA 31008-3923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2014 |
Last Update Date | 07/08/2014 |