Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT002847 | GA |
N | 225XH1200X | Occupational Therapist - Hand | GA |
NPI | 1245294420 |
---|---|
Provider Name | Kevin Roulhac |
First Address | Alpharetta, GA 30005 |
Second Address | Alpharetta, GA 30005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 14/09/2007 |