Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT002845 | GA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT002845 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT002845 | GA |
NPI | 1962469924 |
---|---|
Provider Name | Mrs. Diane Constance Mccluskey |
First Address | Kennesaw, GA 30144-1888 |
Second Address | Kennesaw, GA 30144-1888 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00907552A | (05) | GA |
52748468 | (02) | GA |
P81001 | (02) | GA |