Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT001052 | GA |
NPI | 1174070742 |
---|---|
Provider Name | Gary Love |
First Address | Saint Simons Island, GA 31522-8840 |
Second Address | Saint Simons Island, GA 31522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2016 |
Last Update Date | 01/09/2016 |