Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 9853 | NC |
NPI | 1548790363 |
---|---|
Provider Name | Allyson Wakeman |
First Address | Winston Salem, NC 27106-3216 |
Second Address | Winston Salem, NC 27106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2017 |
Last Update Date | 14/06/2017 |