Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist |
NPI | 1114486529 |
---|---|
Provider Name | Clarissa Rose |
First Address | Orlando, FL 32886-5109 |
Second Address | Greenville, SC 29605-4255 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2019 |
Last Update Date | 15/03/2019 |