Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT002478 | GA |
NPI | 1063718286 |
---|---|
Provider Name | Mr. Sean Charles Slaughter |
First Address | Columbus, GA 31904-3638 |
Second Address | Columbus, GA 31904-3638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2011 |
Last Update Date | 04/02/2011 |