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General NPI Number Information
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NPI Number | 1487126827
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Entity Type | Individual
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Provider Name | SUMMER NICOLE LOUGHRIDGE
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Gender | Female
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Dates
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Enumeration Date | 12/26/2018
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Last Update Date | 12/26/2018
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Provider Practice Location Address
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Address Line | 2403 BATTLEFIELD PKWY
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City | FT OGLETHORPE
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State | GA
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Zip | 30742-4033
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Country | US
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Telephone | 423-595-4246
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Fax |
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Provider Business Mailing Address
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Address Line | 13530 HIGHWAY 151
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City | TRION
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State | GA
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Zip | 30753-1930
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Country | US
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Telephone |
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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 | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA000920
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License Number State | GA
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