Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1073708830 |
---|---|
Provider Name | Clarissa Stewart Reynolds |
First Address | Hamlet, NC 28345-0791 |
Second Address | Hamlet, NC 28345-3629 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2007 |
Last Update Date | 16/04/2015 |