Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 4590 | NC |
NPI | 1154830149 |
---|---|
Provider Name | Andrew St George Gladding |
First Address | Asheville, NC 28803-2907 |
Second Address | Black Mountain, NC 28711-7733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2017 |
Last Update Date | 22/09/2017 |