Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT000673 | GA |
Y | 225XH1200X | Occupational Therapist - Hand | OT000673 | GA |
NPI | 1245336981 |
---|---|
Provider Name | Mrs. Carla Bader-Henderson |
First Address | Atlanta, GA 30339-3035 |
Second Address | Stockbridge, GA 30281-5170 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2006 |
Last Update Date | 07/07/2015 |