Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT002332 | GA |
NPI | 1053559823 |
---|---|
Provider Name | Michele Cary |
First Address | Atlanta, GA 30358-0528 |
Second Address | Atlanta, GA 30319-1624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2009 |
Last Update Date | 01/02/2009 |