Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 02440 | NE |
Y | 225XG0600X | Occupational Therapist - Gerontology | 02440 | NE |
N | 225XM0800X | Mental Health | 02440 | NE |
NPI | 1346673464 |
---|---|
Provider Name | Mrs. Suzetta Rogers Brazile |
First Address | Sharpsburg, GA 30277-1853 |
Second Address | Sharpsburg, GA 30277-1853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2013 |
Last Update Date | 13/08/2013 |