Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 3853 | AZ |
NPI | 1073714648 |
---|---|
Provider Name | Christian Hope Fortunato |
First Address | Clayton, NC 27520-3655 |
Second Address | Clayton, NC 27520-3655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 07/11/2017 |