Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 14495 | NC |
NPI | 1003579368 |
---|---|
Provider Name | Carly Rochelle Maready |
First Address | Jacksonville, NC 28546-9295 |
Second Address | Jacksonville, NC 28546-6760 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2021 |
Last Update Date | 24/01/2022 |