Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1063183242 |
---|---|
Provider Name | Lauren Ashley Maeder |
First Address | Atlanta, GA 30309-1472 |
Second Address | Tyrone, GA 30290-1640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2021 |
Last Update Date | 27/09/2021 |