Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA000187 | GA |
NPI | 1013208875 |
---|---|
Provider Name | Miracle Watkins |
First Address | Bethlehem, GA 30620-4696 |
Second Address | Monroe, GA 30656-4605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2011 |
Last Update Date | 28/04/2011 |