Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224P00000X | Prosthetist | CP1596 | SC |
N | 225000000X | Orthotic Fitter | RFO01196 | SC |
NPI | 1548308695 |
---|---|
Provider Name | Alvin W. Pickering |
First Address | Orangeburg, SC 29115-4687 |
Second Address | Orangeburg, SC 29115-6022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DE1524 | (05) | SC |