Provider Demographics
NPI:1386775914
Name:WESSON, CONSTANCE JANE (OTRL,CHT)
Entity type:Individual
Prefix:MRS
First Name:CONSTANCE
Middle Name:JANE
Last Name:WESSON
Suffix:
Gender:F
Credentials:OTRL,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 HIGH BLUFF COURT
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061
Mailing Address - Country:US
Mailing Address - Phone:478-550-5750
Mailing Address - Fax:478-452-6255
Practice Address - Street 1:571 HAMMOCK RD NW STE 106
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-7185
Practice Address - Country:US
Practice Address - Phone:478-452-6252
Practice Address - Fax:478-452-6255
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001535225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist