Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003421876 |
---|---|
Provider Name | Annie Carolina Mccollum |
First Address | Raleigh, NC 27607-7511 |
Second Address | Raleigh, NC 27607-7511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2020 |
Last Update Date | 05/05/2021 |