Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT005350 | GA |
NPI | 1205285939 |
---|---|
Provider Name | Nicole Zimmermann |
First Address | Valdosta, GA 31602-1735 |
Second Address | Valdosta, GA 31602-1735 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2016 |
Last Update Date | 03/06/2016 |