Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OT005047 | GA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT005047 | GA |
NPI | 1851539787 |
---|---|
Provider Name | Mrs. Karen Osbourn Waites |
First Address | St Simons Island, GA 31522-8898 |
Second Address | Brunswick, GA 31520-3016 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2009 |
Last Update Date | 06/11/2021 |