Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 002781 | GA |
NPI | 1013680081 |
---|---|
Provider Name | Tomas Sablon |
First Address | Woodstock, GA 30188-7134 |
Second Address | Woodstock, GA 30188-7134 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2021 |
Last Update Date | 27/07/2021 |