Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT003248 | GA |
NPI | 1063455145 |
---|---|
Provider Name | Kimberly Grubbs Snyder |
First Address | Augusta, GA 30907-2220 |
Second Address | Augusta, GA 30907-2220 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 31/10/2007 |