Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1073924940 |
---|---|
Provider Name | B. Scott Goralnik |
First Address | Ormond Beach, FL 32174-4447 |
Second Address | Ormond Beach, FL 32174-4447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2014 |
Last Update Date | 14/05/2014 |