Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT002378 | GA |
NPI | 1255576898 |
---|---|
Provider Name | Mickey Stone |
First Address | Athens, GA 30606-2853 |
Second Address | Athens, GA 30606-2853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2008 |
Last Update Date | 11/12/2008 |