Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT005869 | GA |
NPI | 1184049306 |
---|---|
Provider Name | Mr. Leocharlson Jean-Louis |
First Address | Jonesboro, GA 30236-1099 |
Second Address | Jonesboro, GA 30236-1099 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2014 |
Last Update Date | 25/02/2014 |