Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 10834 | NC |
NPI | 1215457759 |
---|---|
Provider Name | Danielle Beauchamp |
First Address | Charlotte, NC 28203 |
Second Address | Charlotte, NC 28203-5814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2017 |
Last Update Date | 24/07/2017 |