Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | ||
Y | 224Z00000X | Occupational Therapy Assistant | OTA001313 | GA |
NPI | 1023576550 |
---|---|
Provider Name | Jaimie Sims |
First Address | Marietta, GA 30060-6940 |
Second Address | Marietta, GA 30060-6940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2019 |
Last Update Date | 04/03/2019 |