Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | 000828974 | NC |
NPI | 1164798054 |
---|---|
Provider Name | Betty J Powell |
First Address | Wilson, NC 27893-3566 |
Second Address | Wilson, NC 27893-3566 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2012 |
Last Update Date | 26/03/2012 |