Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | ||
N | 225X00000X | Occupational Therapist | OT003050 | GA |
NPI | 1003823485 |
---|---|
Provider Name | Tamara Loutricia Mills |
First Address | Rex, GA 30273-5215 |
Second Address | Rex, GA 30273-5215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 08/07/2007 |