Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | 1059 | GA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 1059 | GA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1059 | GA |
NPI | 1376936674 |
---|---|
Provider Name | Michelle Donley |
First Address | Roswell, GA 30075-1417 |
Second Address | Roswell, GA 30075-1417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2015 |
Last Update Date | 10/03/2015 |