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Contact Information

MIA FULLER, MS,OTR,CHT
11180 STATE BRIDGE RD
SUITE 305
ALPHARETTA, GA30022-7482
 Phone: 678-992-0303
 Fax: 678-992-0302
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Occupational Therapist

225X00000X 67 Occupational Therapist in Private Practice
 

Hand

225XH1200X 67 Occupational Therapist in Private Practice
Indicates primary specialty

NPI Profile & details for MIA FULLER · (Female)

NPI Number 1619045770
Status Active
Credentials MS,OTR,CHT
Entity Individual
Enumeration date 11/30/2006
Last updated 08/16/2019 - About 7 years ago
Sole proprietor 1 No
Identifiers
  • GA License # OT000932
  • GA Medicaid 501099970B
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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