Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT004430 | GA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT004430 | GA |
NPI | 1043837131 |
---|---|
Provider Name | Karra Keith Stephens |
First Address | Gainesville, GA 30506-7514 |
Second Address | Cleveland, GA 30528-1464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2020 |
Last Update Date | 06/07/2020 |