Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251H1200X | Hand | 9711000225 | GA |
Y | 225X00000X | Occupational Therapist | 1111 | GA |
NPI | 1396828166 |
---|---|
Provider Name | Heather Clancy Williamson |
First Address | Alpharetta, GA 30022 |
Second Address | Lawrenceville, GA 30043 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 28/11/2018 |