Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT004928 | GA |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT004928 | GA |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT004928 | GA |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT004928 | GA |
NPI | 1740314517 |
---|---|
Provider Name | Mrs. Lekesiah Nelson Mosby |
First Address | Alpharetta, GA 30004-8048 |
Second Address | Smyrna, GA 30080-7639 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2007 |
Last Update Date | 06/04/2019 |