Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 20380 | CA |
Y | 225X00000X | Occupational Therapist | OT007617 | GA |
NPI | 1003455825 |
---|---|
Provider Name | Kristie Lynn Ronzo |
First Address | Watkinsville, GA 30677-6073 |
Second Address | Watkinsville, GA 30677-6073 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2019 |
Last Update Date | 31/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT007617 | PROFESSIONAL LICENSE (01) | GA |