Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA01767 | GA |
NPI | 1013565746 |
---|---|
Provider Name | Taiwo Alonge |
First Address | Canton, GA 30114-3209 |
Second Address | Canton, GA 30114-3209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2019 |
Last Update Date | 27/08/2019 |