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General NPI Number Information
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NPI Number | 1831332378
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Entity Type | Individual
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Provider Name | MELISSA CANNON OTR/L
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Gender | Female
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 5805 STATE BRIDGE RD STE G321
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City | DULUTH
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State | GA
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Zip | 30097-8220
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Country | US
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Telephone | 770-713-3728
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Fax |
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Provider Business Mailing Address
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Address Line | 6325 HAMPTON CREEK DR
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City | CUMMING
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State | GA
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Zip | 30041-4032
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Country | US
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Telephone | 404-966-4009
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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 | 001926
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License Number State | GA
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