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General NPI Number Information
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NPI Number | 1235324088
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Entity Type | Individual
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Provider Name | KEISHA MONIQUE SPRINGER O.T.
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Gender | Female
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Dates
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Enumeration Date | 09/13/2007
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Last Update Date | 09/13/2007
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Provider Practice Location Address
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Address Line | 5787 MITCHELL CHASE TRL
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City | MABLETON
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State | GA
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Zip | 30126-3473
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Country | US
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Telephone | 678-613-0001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 360710
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City | DECATUR
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State | GA
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Zip | 30036-0710
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Country | US
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Telephone | 678-613-0001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 002668
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License Number State | GA
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