Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT005640 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT005640 | GA |
NPI | 1154662914 |
---|---|
Provider Name | Mrs. Amy Siegel |
First Address | Atlanta, GA 30312-1212 |
Second Address | Atlanta, GA 30312-5166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2013 |
Last Update Date | 14/06/2016 |