Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XP0200X | Occupational Therapist - Pediatrics | OT003716 | GA |
NPI | 1033286133 |
---|---|
Provider Name | Kristen Sipe |
First Address | Lawrenceville, GA 30044-4608 |
Second Address | Lawrenceville, GA 30044-4608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10037764 | (05) | GA |
306066 | (05) | GA |