Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | CFO05278 | ND |
NPI | 1639750755 |
---|---|
Provider Name | Caroline Ann Spacek |
First Address | Fargo, ND 58104-8835 |
Second Address | Fargo, ND 58104-8835 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 20/04/2021 |