Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT008275 | GA |
NPI | 1003571746 |
---|---|
Provider Name | Lauren Hyland Tillerson |
First Address | Atlanta, GA 30342-5022 |
Second Address | Atlanta, GA 30342-5022 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2021 |
Last Update Date | 08/11/2021 |