Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 002192 | GA |
NPI | 1003019332 |
---|---|
Provider Name | Mrs. Sunette Payne |
First Address | Pine Mountain, GA 31822-3237 |
Second Address | Warm Springs, GA 31830 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2007 |
Last Update Date | 08/07/2007 |