Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT004950 | GA |
NPI | 1245570373 |
---|---|
Provider Name | Heather Woodruff Smith |
First Address | Richmond Hill, GA 31324-5134 |
Second Address | Richmond Hill, GA 31324-5134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2013 |
Last Update Date | 27/02/2013 |