Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO03036 | NC |
NPI | 1346436938 |
---|---|
Provider Name | Bonnie L. Laster |
First Address | Salisbury, NC 28144-2312 |
Second Address | Salisbury, NC 28144-2312 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2007 |
Last Update Date | 18/09/2007 |