Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT0004263 | GA |
N | 225XH1200X | Occupational Therapist - Hand | OT2411 | FL |
NPI | 1164765939 |
---|---|
Provider Name | Phyllis Nessell Denton |
First Address | Grayson, GA 30017-1166 |
Second Address | Grayson, GA 30017-1166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2013 |
Last Update Date | 31/03/2013 |