Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0413 | GA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0413 | GA |
NPI | 1033270061 |
---|---|
Provider Name | Mrs. Denise Walz Vermilya |
First Address | Marietta, GA 30066-0121 |
Second Address | Marietta, GA 30066-1541 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2006 |
Last Update Date | 02/12/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0413 | OCCUPATIONAL THERPAY LICE (01) | GA |
643429152A | (05) | GA |