Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA001521 | GA |
NPI | 1013522556 |
---|---|
Provider Name | Jessica Sledge |
First Address | Atlanta, GA 30324-5676 |
Second Address | Atlanta, GA 30328-4221 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 11/09/2020 |