Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 8473 | NC |
NPI | 1063829026 |
---|---|
Provider Name | Bridgette Mcdougal |
First Address | Durham, NC 27707-2517 |
Second Address | Durham, NC 27707-2517 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 22/07/2014 |