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General NPI Number Information
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NPI Number | 1326463688
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Entity Type | Individual
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Provider Name | ANISSA PRESLEY-RADFORD
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Gender | Female
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Dates
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Enumeration Date | 02/24/2014
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Last Update Date | 03/04/2014
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Provider Practice Location Address
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Address Line | 136 LUMBY LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-0908
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Country | US
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Telephone | 770-827-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 136 LUMBY LN
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-0908
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Country | US
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Telephone | 770-827-0900
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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 | OT002956
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License Number State | GA
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