Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | SC |
NPI | 1023153681 |
---|---|
Provider Name | Carla O Boiter |
First Address | Easton, PA 18040-7958 |
Second Address | Greenville, SC 29607-5956 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 09/07/2007 |