Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT006783 | GA |
NPI | 1053832493 |
---|---|
Provider Name | Stepanie Bays |
First Address | Rome, GA 30165-2802 |
Second Address | Rome, GA 30165-2802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2017 |
Last Update Date | 06/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT006783 | STATE LICENSE (01) | GA |