Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA001147 | GA |
NPI | 1023677440 |
---|---|
Provider Name | Laura B Ferguson |
First Address | Martinez, GA 30907-2329 |
Second Address | Augusta, GA 30909-1867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2019 |
Last Update Date | 10/06/2019 |